Advances and controversies in partial nephrectomy for T 3a renal cell carcinoma
10.3760/cma.j.cn112330-20240625-00286
- VernacularTitle:肾部分切除术后病理分期升级为T 3a期肾癌的诊治现状和诊断技术进展
- Author:
Jinghui JI
1
;
Xiushi LIN
1
;
Xiaojun TIAN
1
;
Min QIU
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;
Pathologic upgrading;
Partial nephrectomy;
Radical nephrectomy
- From:
Chinese Journal of Urology
2025;46(8):632-635
- CountryChina
- Language:Chinese
-
Abstract:
Renal cell carcinoma（RCC）has a relatively high incidence among genitourinary malignancies and therefore occupies a pivotal position in the diagnosis and treatment of urological tumors. Its staging，grading，and corresponding therapeutic strategies have been relatively well established. However，in clinical practice，we have observed that a subset of patients with RCC，preoperatively diagnosed as stage T1 based on imaging，are found on postoperative pathology after partial nephrectomy to have tumor extension into the renal sinus，resulting in pathological upstaging（cT 1/pT 3a）. Multiple studies have demonstrated that the overall prognosis of cT 1/pT 3a patients undergoing partial nephrectomy is inferior to that of cT 1/pT 1 patients，but shows no significant difference compared with cT 1/pT 3a patients treated with radical nephrectomy. Moreover，partial nephrectomy offers clear advantages over radical nephrectomy in terms of intraoperative blood loss and preservation of renal function parameters such as estimated glomerular filtration rate（eGFR）and serum creatinine，which translate into improved quality of life. In addition，this paper introduces predictive methods for pathological upstaging in partial RCC，including novel imaging-based approaches such as the contour irregular degree（CID）on computed tomography（CT），histopathological predictors such as Fuhrman grading，and the preliminary application of machine learning in enhancing diagnostic accuracy.
