Lundstam Sven, Almdalal Tarik, Rosenblad Andreas Karlsson, Ljungberg Börje
Departments of Urology and Oncology, University of Gothenburg Sahkgrenska Academy, Gothenburg, Sweden.
Department of Surgery and Urology, Eskilstuna County Hospital, Eskilstuna, Sweden.
Urol Res Pract. 2025 Apr 4;50(6):322-327. doi: 10.5152/tud.2025.24081.
Renal cell carcinoma (RCC) patients in clinical T1 RCC generally exhibit a favorable prognosis. Guidelines recommend partial nephrectomy (PN), also for cT1b RCCs. Despite a favorable prognosis, there remains risks for upstaging and recurrence for cT1b RCC patients, and the preference for PN has been questionable. Clinical and morphological variables and overall survival (OS) were characterized in a national realworld population.
Data from the the National Swedish Kidney Cancer Register 2005-2014, with non-metastatic cT1bRCC patients treated surgically and having !5 years potential follow-up were included (n = 2006). Patients gender, age, stage, tumor size, RCC type, local and distant tumor recurrence were evaluated.
Among 2006 patients (1219 males, 787 females; mean age 66 years), 1705 underwent radical nephrectomy (RN), and 301 PN. Upstage from cT1b to pathological T3a occurred in 304 (15%) patients. Recurrent disease was diagnosed in 318 (16%) patients, with higher rates in pT3a (25%) compared to pT1b (14%). There was no significant difference in disease recurrences observed between the surgical techniques. Factors associated with increased recurrence risk included age, T-stage, N-stage, and tumor size, while papillary and chromophobe RCCs were associated with decreased risk. Patients with pT3a RCC had a worse 5-year OS rate (67%) compared with pT1b (83%; P < .001, log-rank test). In adjusted analyses, age, tumor size, pT-stage, and pN- stage were associated with OS, while treatment with PN was non-inferior compared with RN (hazard ratio 0.91, 95% CI: 0.71-1.45, P = .431).
Patients with clinical T1b RCCs face a non-negligible risk for tumor upstaging, disease recurrence, and decreased OS. The adjusted analyses showed that PN was non-inferior to RN, supporting the recommendation to offer PN.
临床T1期肾细胞癌（RCC）患者通常预后良好。指南推荐对cT1b期RCC也采用部分肾切除术（PN）。尽管预后良好，但cT1b期RCC患者仍存在分期上升和复发的风险，对PN的偏好一直存在疑问。在全国真实世界人群中对临床和形态学变量及总生存期（OS）进行了特征分析。
纳入瑞典国家肾癌登记处2005 - 2014年的数据，包括接受手术治疗且有至少5年潜在随访期的非转移性cT1b期RCC患者（n = 2006）。评估患者的性别、年龄、分期、肿瘤大小、RCC类型、局部和远处肿瘤复发情况。
在2006例患者中（1219例男性，787例女性；平均年龄66岁），1705例行根治性肾切除术（RN），301例行PN。304例（15%）患者从cT1b期上升至病理T3a期。318例（16%）患者被诊断为疾病复发，pT3a期患者的复发率（25%）高于pT1b期（14%）。手术技术之间在疾病复发方面未观察到显著差异。与复发风险增加相关的因素包括年龄、T分期、N分期和肿瘤大小，而乳头状和嫌色性RCC的复发风险较低。pT3a期RCC患者的5年总生存率（67%）低于pT1b期（83%；P <.001，对数秩检验）。在多因素分析中，年龄、肿瘤大小、pT分期和pN分期与总生存期相关，而PN治疗与RN相比并不逊色（风险比0.91，95%可信区间：0.71 - 1.45，P =.431）。
临床T1b期RCC患者面临肿瘤分期上升、疾病复发和总生存期降低的不可忽视的风险。多因素分析表明PN不劣于RN，支持推荐采用PN。
