Practice Update | Onology

GENITOURINARY 27

Similar oncological outcomes with partial and radical nephrectomy in RCC ≥4 cm Urologic Oncology: Seminars & Original Investigations Take-home message

• In a retrospective analysis, researchers compared the outcomes of radical nephrectomy with outcomes of partial nephrectomy (PN) in renal cell carcinoma (RCC) ≥4 cm. Using propensity scorematching, they found no differences in progression-free, cancer-specific, or overall survival between radical and partial nephrectomy. However, the PN group did experience more complications within 30 days after surgery (P < 0.001). Survival was associated with tumor size, cellular grade, pathologic state, and patient age. • Oncological outcomes were found to be similar with partial and radical nephrectomy in RCC ≥4 cm, and the authors suggest that PN remains a valuable treatment option even though the early complication rate was higher with PN compared with the radical approach.

Although the early complication rate was significantly higher after PN, it should be considered as a valuable treatment option even in patients with clinical T1b or higher RCC.

invasion. In contrast, MIBC urine and plasma tDNA levels correlated with one another (r = 0.6). In patients with NMIBCs, urine tDNA lev- els correlated with progression, even when tumors were stratified by stage (although, in patients with T1 tumors, the results just missed statistical significance). In patients with MIBC, plasma tDNA levels were asso- ciated with recurrence (P < 0.001). Overall, the Christensen study reinforces the group’s previous conclusion 9 that measuring tumor DNA alterations in urine (NMIBC and MIBC) and plasma (MIBC) is feasible and probably clinically impactful. However, important questions remain. First and foremost, it is still not clear that meas- uring tDNA in urine will outperform routine cystoscopy, and more longitudinal studies need to be performed to determine how tumor resection and intravesical therapy affect tDNA levels. The longitudinal data presented in Figure 3 are very interesting but do not directly address how clinical management impacts the amount of tDNA Abstract OBJECTIVE Although partial nephrectomy (PN) is the standard treatment for localized clinical T1a renal cell carcinoma (RCC), treatment of larger renal tumors is controversial. We evaluated the oncological outcomes and perioperative com- plications after radical and PN for RCC ≥4cm. PATIENTS AND METHODS We retrospectively analyzed the data of 2,373 patients surgically treated for nonmetastatic RCC with clinical T1b or T2 (≥4cm). The propensity scores for surgery type were calculated, and the partial group was matched to the radical group in a 1:3 ratio. The oncological outcomes were compared using Kaplan-Meier analysis and multivariate Cox regression models were used to identify the independent predictors of progression-free, cancer-specific, and overall survival.

CONCLUSIONS The partial and radical nephrec- tomy groups had equivalent oncological outcomes. Although the early complication rate was significantly higher after PN, it should be considered as a valuable treatment option even in patients with clinical T1b or higher RCC. Can partial nephrectomy provide equal onco- logical efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4cm)? A propensity score-matched study. Urol Oncol 2017 Mar 08;[EPub Ahead of Print], H Lee, JJ Oh, SS Byun, et al.

that is present. Related to this point, the sensitivity of the ddPCR assay in detecting subclinical disease is still not clear. Ideally, increases in tDNA should anticipate the emergence of clinically evident disease as measured by cystoscopy and/or cytology (hopefully by several weeks or months). Finally, it would be preferable to have a “tumor-agnostic” test that is capable of detecting all bladder cancers without the need to perform whole or panel exome sequencing on a patient’s primary tumor to identify relevant biomarkers. Commer- cial vendors like UrologyDx, Guardant, and PGDx are developing such panels, but it will take some time to fully appreciate their performance characteristics. Nev- ertheless, this study represents another important step forward in the integration of genomics into the routine clinical man- agement of patients with bladder cancer. Building on this foundation, we will hope- fully see robust urine- and plasma-based tests emerge in the next 1 to 2 years. RESULTS All differences in preoperative clini- cal characteristics disappeared after matching. There were no significant differences in pro- gression-free, cancer-specific, or overall survival between the partial and radical groups in the matched cohort. The patients’ age, tumor size, cellular grade, and pathologic stage were inde- pendent predictors for all 3 survival outcomes. However, early complications (<30d postoper- ative) were significantly more common in the partial group (P<0.001). In a subgroup analysis of the patients with clinical T2 stage, there were no significant differences in all 3 survival outcomes.

Dr McConkey is Professor in the Departments of Urology and Cancer Biology and Director of Urological Research at Johns Hopkins in Baltimore, Maryland.

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VOL. 1 • NO. 2 • 2017