Cao Yudong, Cui Yushuang, Li Ruojing, Tang Xingxing, Lin Chen, Yang Xiao, Liu Jia, Zhao Qiang, Ma Jinchao, de Oliveira Paludo Artur, Schmeusser Benjamin N, Wang Shuo, Du Peng
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Urology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.
Transl Androl Urol. 2025 Mar 30;14(3):740-750. doi: 10.21037/tau-2025-136. Epub 2025 Mar 26.
Radical nephrectomy (RN) and partial nephrectomy (PN) are common surgical treatments for T1 stage renal cell carcinoma (RCC). However, the long-term impact of these surgical approaches on prognosis and renal function remains an area of ongoing investigation. This study compared the effects of these procedures on prognosis and renal function.
The data of 1,030 T1 stage RCC patients treated at Peking University Cancer Hospital & Institute between January 2014 and August 2022 were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). The secondary endpoints included the annual mean estimated glomerular filtration rate (eGFR) and the average annual eGFR change rates.
Based on a median follow-up time of 57 months, the OS and CSS rates were 96.6% and 98.5% in the overall cohort, respectively. The multivariate analysis identified age [hazard ratio (HR), 2.664; 95% confidence interval (CI): 1.147-6.192; P=0.02], tumor grade (HR, 2.247; 95% CI: 1.050-4.810; P=0.04), and surgical approach (HR, 2.585; 95% CI: 1.056-6.325; P=0.04) as adverse prognostic factors for OS, and age (HR, 4.603; 95% CI: 1.035-20.471; P=0.045) and tumor grade (HR, 4.972; 95% CI: 1.752-14.111; P=0.003) as adverse prognostic factors for CSS. Throughout the follow-up period, the eGFR of the RN patients showed a gradual increase, while that of the PN patients remained stable (P<0.001). Among the patients with preoperative diabetes, the eGFR of the RN patients decreased significantly compared to that of the PN patients (P=0.03).
T1 stage RCC has a favorable prognosis with surgery, and PN is an oncologically safe option. A persistent eGFR difference was observed between the PN and RN groups, with RN showing a gradual upward trend. However, patients with pre-existing diabetes experienced a greater decline in renal function after RN, which highlights the advantages of PN for such patients.
根治性肾切除术（RN）和部分肾切除术（PN）是T1期肾细胞癌（RCC）的常见外科治疗方法。然而，这些手术方式对预后和肾功能的长期影响仍是一个正在研究的领域。本研究比较了这些手术对预后和肾功能的影响。
分析了2014年1月至2022年8月在北京大学肿瘤医院接受治疗的1030例T1期RCC患者的数据。该研究的主要终点是总生存期（OS）和癌症特异性生存期（CSS）。次要终点包括年平均估计肾小球滤过率（eGFR）和年平均eGFR变化率。
中位随访时间为57个月，整个队列的OS率和CSS率分别为96.6%和98.5%。多因素分析确定年龄[风险比（HR），2.664；95%置信区间（CI）：1.147 - 6.192；P = 0.02]、肿瘤分级（HR，2.247；95% CI：1.050 - 4.810；P = 0.04）和手术方式（HR，2.585；95% CI：1.056 - 6.325；P = 0.04）是OS的不良预后因素，年龄（HR，4.603；95% CI：1.035 - 20.471；P = 0.045）和肿瘤分级（HR，4.972；95% CI：1.752 - 14.111；P = 0.003）是CSS的不良预后因素。在整个随访期间，RN患者的eGFR呈逐渐上升趋势，而PN患者的eGFR保持稳定（P < 0.001）。在术前患有糖尿病的患者中，RN患者的eGFR较PN患者显著下降（P = 0.03）。
T1期RCC手术预后良好，PN是一种肿瘤学上安全的选择。PN组和RN组之间观察到持续的eGFR差异，RN呈逐渐上升趋势。然而，术前患有糖尿病的患者在RN术后肾功能下降更大，这突出了PN对此类患者的优势。
