Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: A systematic review and meta-analysis of retrospective studies

doi:10.1016/j.ajur.2019.11.004

Asian Journal of Urology, 2021, 8 (1): 117-125 doi: 10.1016/j.ajur.2019.11.004

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Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: A systematic review and meta-analysis of retrospective studies

Yucong Zhang^a,b,c,1,Gongwei Long^a,b,1,Haojie Shang^a,Beichen Ding^a,b,Guoliang Sun^a,b,Wei Ouyang^a,b,Man Liu^a,b,Yuan Chen^a,Heng Li^a,b,*(

),Hua Xu^a,b,Zhangqun Ye^a,b

^a Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^b Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^c Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Abstract

Objective: To conduct a meta-analysis assessing the perioperative, functional and oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for T1b tumours. The primary endpoints were the oncological outcomes. The secondary endpoints were the perioperative and functional outcomes.

Methods: A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.

Results: Overall, 13 retrospective cohort studies were included in the analysis. Patients undergoing PN were younger (weighted mean difference [WMD] -3.49 years, 95% confidence interval [CI] -5.16 to -1.82; p<0.0001) and had smaller masses (WMD -0.45 cm, 95% CI -0.59 to -0.31; p<0.0001). There were no differences in the oncological outcome, which was demonstrated by progression-free survival (hazard ratio [HR] 0.70; p=0.22), cancer-specific mortality (HR 0.91; p=0.57) and all-cause mortality (HR 1.01; p=0.96). The two procedures were similar in estimated blood loss (WMD -16.47 mL; p=0.53) and postoperative complications (risk ratio [RR] 1.32; p=0.10), and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset (RR 0.38; p=0.006).

Conclusion: PN is an effective treatment for T1b tumours because it offers similar surgical morbidity, equivalent cancer control, and better renal preservation compared to RN.

Key words： Kidney cancer Partial nephrectomy Radical nephrectomy Renal cancer Survival Renal function

Received: 22 May 2019 Available online: 20 January 2021

Corresponding Authors: Heng Li E-mail: lihengtjmu@163.com

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	Yucong Zhang
	Gongwei Long
	Haojie Shang
	Beichen Ding
	Guoliang Sun
	Wei Ouyang
	Man Liu
	Yuan Chen
	Heng Li
	Hua Xu
	Zhangqun Ye

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Cite this article:

Yucong Zhang,Gongwei Long,Haojie Shang, et al. Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: A systematic review and meta-analysis of retrospective studies[J]. Asian Journal of Urology, 2021, 8(1): 117-125.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.11.004 OR http://www.ajurology.com/EN/Y2021/V8/I1/117

PRISMA flow chart of the study identification process. Of the 14 studies ultimately included, in one case, the same group reported two separate analyses for different endpoints (Roos et al. [19,20]; see the text). PN, partial nephrectomy; RN, radical nephrectomy; PRISMA, the Preferred Reporting Items for Systematic Reviews and Meta-analysis.

Studies included in the meta-analysis for assessment of outcomes for PN versus RN for cT1b and higher renal tumours.

Summary of baseline characteristics and outcomes of different analyses.

Forest plots of cancer progression after PN versus RN for T1b tumours. (A) Forest plot of progression-free survival for PN versus RN for T1b tumours; (B) Forest plot of recurrence rate for PN versus RN for T1b tumours. PN, partial nephrectomy; RN, radical nephrectomy; SE, standard error; CI, confidence interval.

Forest plot of cancer-specific survival for PN versus RN for T1b tumours. PN, partial nephrectomy; RN, radical nephrectomy; SE, standard error; CI, confidence interval.

Forest plot of postoperative complications for PN versus RN for T1b tumours. PN, partial nephrectomy; RN, radical nephrectomy; CI, confidence interval.

Forest plot of onset of CKD for PN versus RN for T1b tumours. CKD, chronic kidney disease; PN, partial nephrectomy; RN, radical nephrectomy; CI, confidence interval.

Funnel plot of the studies included in the meta-analysis reporting cancer-specific survival. SE, standard error.

Adjusted factors of oncological outcomes.

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