Oncologic and Functional Outcomes of Radical and Partial Nephrectomy in pT3a Pathologically Upstaged Renal Cell Carcinoma: A multi-institutional analysis

Abstract Background Efficacy of Partial Nephrectomy (PN) in setting of pT3a pathologic-upstaged Renal Cell Carcinoma (RCC) is controversial. We compared oncologic and functional outcomes of Radical Nephrectomy (RN) and PN in patients with upstaged pT3a RCC. Methods Multicenter retrospective analysis of patients with cT1−2N0M0 RCC upstaged to pT3a postoperatively. Primary outcome was Recurrence-Free Survival (RFS), with secondary outcomes Overall Survival (OS) and de novo eGFR Results 929 patients had pT3a upstaging [686 (72.6%) RN/243 (25.7%) PN; mean follow up 48 months]. Tumor size was similar (RN 7.7 cm vs. PN 7.3 cm, p=0.083). PN had decreased ΔeGFR (6.1 vs. RN 19.4 ml/min/1.73m2, p Conclusions In pathologically upstaged pT3a RCC, PN did not adversely affect risk of recurrence and provided functional benefit. Surgical decision-making in patients at risk for T3a upstaging should be individualized and driven by tumor as well as functional risks.