Tian Cong, Liu Jun, Wang Yueyao, An Lizhe, Hong Yang, Hu Haopu, Wang Mingrui, Bian Xiaolong, Lai Jinhui, Hu Hao
Department of Urology, Peking University People's Hospital, Beijing, China.
Peking University Applied Lithotripsy Institute, Peking University, Beijing, China.
Transl Androl Urol. 2025 Mar 30;14(3):669-677. doi: 10.21037/tau-2024-637. Epub 2025 Mar 26.
Distant metastases can still occur in T1a renal cancer. There is no conclusive evidence to determine whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN) is superior in managing primary renal lesions. This study aimed to compare survival outcomes between cPN and cRN in pathological T1a renal cell carcinoma (RCC) patients with distant metastases and to develop a predictive model for metastasis risk stratification.
T1a RCC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic comparisons were made using Kaplan-Meier analysis. Univariate and multivariate logistic regression analyses were conducted to assess the risk factors for distant metastases in T1a RCC, leading to the development of a predictive model. The model's performance was evaluated using receiver operating characteristic (ROC) curves.
The study included 55,957 RCC patients with pathologic T1a, of which 1,496 (2.67%) with distant metastases. Metastatic patients exhibited significantly worse overall survival (OS) than non-metastatic counterparts (P<0.001). There was no notable difference in OS between cPN and cRN (P=0.11). Univariate and multivariate analyses identified advanced age, male gender, poor histological differentiation, sarcomatoid features, capsular invasion, and lymph node metastasis as independent risk factors for distant metastases in RCC patients with stage T1a. The predictive model established on these factors demonstrated performance with an area under the curve of 0.789.
There was no significant difference in OS between cPN and cRN. Advanced age, male gender, poor histological differentiation, capsular invasion, sarcomatoid features, and lymph node metastasis were independent risk factors for distant metastases in RCC patients with stage T1a.
T1a期肾癌仍可发生远处转移。尚无确凿证据确定在处理原发性肾脏病变时，减瘤性部分肾切除术（cPN）或减瘤性根治性肾切除术（cRN）哪种更具优势。本研究旨在比较接受cPN和cRN治疗的伴有远处转移的病理T1a期肾细胞癌（RCC）患者的生存结局，并建立转移风险分层的预测模型。
从监测、流行病学和最终结果（SEER）数据库中提取T1a期RCC患者。采用Kaplan-Meier分析进行预后比较。进行单因素和多因素逻辑回归分析，以评估T1a期RCC远处转移的危险因素，从而建立预测模型。使用受试者工作特征（ROC）曲线评估该模型的性能。
该研究纳入了55957例病理T1a期RCC患者，其中1496例（2.67%）发生远处转移。转移患者的总生存期（OS）明显差于未转移患者（P<0.001）。cPN和cRN之间的OS无显著差异（P=0.11）。单因素和多因素分析确定高龄、男性、组织学分化差、肉瘤样特征、包膜侵犯和淋巴结转移是T1a期RCC患者远处转移的独立危险因素。基于这些因素建立的预测模型的曲线下面积为0.789。
cPN和cRN之间的OS无显著差异。高龄、男性、组织学分化差、包膜侵犯、肉瘤样特征和淋巴结转移是T1a期RCC患者远处转移的独立危险因素。
