Saitta Cesare, Autorino Riccardo, Capitanio Umberto, Lughezzani Giovanni, Meagher Margaret F, Yim Kendrick, Nguyen Mimi V, Mantovani Matilde, Guer Melis, Amparore Daniele, Piramide Federico, Hakimi Kevin, Patil Dattatraya, Tanaka Hajime, Fukuda Shohei, Kobayashi Masaki, Chen Wei, Pandolfo Savio D, Cortes Julian, Puri Dhruv, Yuen Kit, Lazzeri Massimo, Fasulo Vittorio, Larcher Alessandro, Paciotti Marco, Garofano Giuseppe, Porpiglia Francesco, Montorsi Francesco, Fujii Yasuhisa, Master Viraj, Buffi Nicolò M, Derweesh Ithaar H
Department of Urology, University of California: San Diego Health System, San Diego, CA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy.
Department of Urology, Rush University, Chicago, IL.
Clin Genitourin Cancer. 2025 Jun;23(3):102343. doi: 10.1016/j.clgc.2025.102343. Epub 2025 Apr 4.
We sought to evaluate oncological and functional outcomes of patients treated with partial nephrectomy (PN) and radical nephrectomy (RN) in pT3aN0M0 renal cell carcinoma (RCC).
We conducted a retrospective analysis of surgically treated pT3aN0M0 RCC patients. Primary outcome was all-cause mortality/overall survival (ACM/OS). Secondary outcomes were cancer-specific mortality/ cancer-specific survival (CSM/CSS), recurrence/progression free survival (PFS) and new onset de novo eGFR < 45 mL/min/1.73 m (CKD-S3b). A propensity score matched model in a 1:1 ratio was conducted, within a caliper width of 0.01. Kaplan-Meier analysis (KMA) and Cox multivariable analysis (MVA) were fitted to delineate survival outcomes and their predictors.
After PSM 359 were analyzed (PN = 179 vs. RN = 180); median follow up of 38.7 (IQR 16.28-64) months. MVA for ACM revealed, high grade (HR 2.05, P = .019), and CKD-S3b at last follow up (HR 2.13, P = .018) as independent risk factors, while RN versus PN (P = .41) was not. MVA for CSM and recurrence revealed that RN versus PN was not an independent risk factor for CSM (P = .088) and recurrence (P = .277). MVA for CKD-S3b revealed RN versus PN (HR 1.67 P = .025) as associated with increased risk of CKD-S3b. KMA comparing PN versus RN revealed 5-year OS of 87.4% versus 82% (P = .26); 5-year CSS of 95.6% versus 90.3% (P = .15); 5-year PFS of 83.5% versus 77% (P = .38); 5-year CKD-S3b free survival of 80.8% versus 65.5% (P = .016).
PN exhibited oncological equipoise while reducing risk of development of eGFR < 45 mL/min/1.73 m. PN may be considered in T3a RCC when prioritization of functional preservation is indicated.
我们试图评估接受部分肾切除术（PN）和根治性肾切除术（RN）治疗的pT3aN0M0肾细胞癌（RCC）患者的肿瘤学和功能结局。
我们对接受手术治疗的pT3aN0M0 RCC患者进行了回顾性分析。主要结局是全因死亡率/总生存期（ACM/OS）。次要结局是癌症特异性死亡率/癌症特异性生存期（CSM/CSS）、无复发/进展生存期（PFS）以及新发的eGFR<45 mL/min/1.73 m²（慢性肾脏病-S3b期）。采用倾向评分匹配模型，比例为1:1，卡尺宽度为0.01。采用Kaplan-Meier分析（KMA）和Cox多变量分析（MVA）来描述生存结局及其预测因素。
倾向评分匹配后分析了359例患者（PN组179例 vs. RN组180例）；中位随访时间为38.7（四分位间距16.28 - 64）个月。ACM的MVA显示，高级别（HR 2.05，P = 0.019）以及末次随访时的慢性肾脏病-S3b期（HR 2.13，P = 0.018）为独立危险因素，而RN与PN相比（P = 0.41）并非独立危险因素。CSM和复发的MVA显示，RN与PN相比并非CSM（P = 0.088）和复发（P = 0.277）的独立危险因素。慢性肾脏病-S3b期的MVA显示，RN与PN相比（HR 1.67，P = 0.025）与慢性肾脏病-S3b期风险增加相关。KMA比较PN与RN显示，5年总生存率分别为87.4%和82%（P = 0.26）；5年癌症特异性生存率分别为95.6%和90.3%（P = 0.15）；5年无进展生存率分别为83.5%和77%（P = 0.38）；5年无慢性肾脏病-S3b期生存率分别为80.8%和65.5%（P = 0.016）。
PN在肿瘤学方面表现相当，同时降低了eGFR<45 mL/min/1.73 m²的发生风险。当需要优先保留功能时，T3a期RCC患者可考虑行PN。
