A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma
10.19723/j.issn.1671-167X.2025.04.012
- VernacularTitle:病理T3a期肾细胞癌肾部分切除与根治性肾切除的回顾性匹配研究
- Author:
Zezhen ZHOU
1
;
Liyuan GE
1
;
Fan ZHANG
1
;
Shaohui DENG
1
;
Ye YAN
1
;
Hongxian ZHANG
1
;
Guoliang WANG
1
;
Lei LIU
1
;
Yi HUANG
1
;
Shudong ZHANG
1
Author Information
1. 北京大学第三医院泌尿外科,北京 100191
- Publication Type:Journal Article
- Keywords:
Renal cell carcinoma;
Partial nephrectomy;
Radical nephrectomy;
Pathological T3a
- From:
Journal of Peking University(Health Sciences)
2025;57(4):704-710
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5％vs.15.2％)and segmental renal vein involvement(42.4％vs.20.8％),but lower rates of renal sinus invasion(RSI,21.2％vs.73.6％)and renal vein tumor thrombus(0％vs.15.2％)compared with the RN group(n=394,all P＜0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P＞0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P＜0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P＞0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P＜0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.
