Survival Outcomes for Partial vs Radical Orchiectomy: Analysis of the National Cancer Database (NCDB)
Radical orchiectomy (RO) is the standard of care for patients with suspicious testicular masses, while partial orchiectomy (PO) is primarily a consideration in patients with bilateral masses or a solitary testicle. Outcomes research has predominantly featured case reports and small case series, while the comparative effectiveness of PO vs RO remains poorly elucidated in contemporary literature. The current study seeks to compare outcomes between these treatment modalities.
The NCDB was queried for all patients treated for testicular cancer between 2004 and 2015. Patients were selected if they obtained either PO or RO. Clinical tumor stage and margin status were noted. Statistical analysis was performed using Fisher’s Exact test for relationships among categorical variables, Kaplan-Meier Curves to evaluate overall survival (OS) and Cox Regression Analysis to compare OS and Hazard Ratios between treatment modalities.
Patients underwent either PO (n=176) or RO (n=49449) orchiectomy. Median followup for all patients queried was 64.1 months (IQR 39.0-96.1). Risk of positive margin status was increased in all patients undergoing PO, regardless of clinical stage (OR=5.77,95%CI 3.86-8.64; p
PO had increased positive margins and positive margins were associated with significantly decreased OS. PO was associated with decreased OS, but insignificant for patients with cT1 disease. PO may have comparable survival outcomes compared to RO for cT1 tumors, but higher clinical stage is associated with a worse prognosis and PO should continue to be approached with caution in select patients.