Liu Ning, Qian Yiguan, Fan Yujing, Li Yang, Ji Chencheng, Zhao Kunlun, Jiang Xiaotian, Xiong Zhongli, Wang Min, Xu Zheng, Xu Luwei, Xu Tao, Jia Ruipeng, Ge Yu-Zheng
Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Ann Surg Oncol. 2025 Jun 19. doi: 10.1245/s10434-025-17642-w.
The therapeutic paradigm for metastatic renal cell carcinoma (mRCC) has experienced a transformative evolution, and cytoreductive nephrectomy remains a clinically viable option in the immunotherapy era. However, the survival benefits of partial nephrectomy (PN) and radical nephrectomy (RN) have yet to be compared. This study aimed to comprehensively compare the outcomes of PN and RN among patients with mRCC in the real-world setting.
The Surveillance, Epidemiology, and End Results (SEER) database was reviewed for patients with mRCC diagnosed between 2016 and 2021 who underwent PN or RN. The endpoints were overall survival (OS), disease-specific survival (DSS), and other-cause specific survival (OCSS). The analytical methods included propensity score matching (PSM), Kaplan‒Meier survival curves, and Cox proportional hazards modeling.
A total of 2775 patients with mRCC were identified, with 134 (4.8%) undergoing PN and 2641 (95.2%) receiving RN. Patients in the PN group were more frequently diagnosed with lower T stage, lower grade, N0, and non-clear cell RCC, whereas those in the RN group exhibited a higher incidence of lung metastasis. Following 1:2 PSM, there was no significant difference in OS, DSS, and OCSS between the groups. Further subgroup analysis indicated that PN may contribute to prolonged OS in patients with mRCC with T1 and N0 disease, whereas patients with N1 mRCC may benefit more from RN.
PN could provide comparable survival benefit as RN for patients with mRCC in the era of immunotherapy. However, preoperative staging and risk stratification are necessary, as the prognosis of mRCC varied between groups with different T or N stages.
转移性肾细胞癌（mRCC）的治疗模式经历了变革性的演变，在免疫治疗时代，减瘤性肾切除术仍是一种临床可行的选择。然而，部分肾切除术（PN）和根治性肾切除术（RN）的生存获益尚未得到比较。本研究旨在全面比较真实世界中mRCC患者接受PN和RN后的结局。
回顾监测、流行病学和最终结果（SEER）数据库中2016年至2021年间诊断为mRCC并接受PN或RN的患者。终点指标为总生存期（OS）、疾病特异性生存期（DSS）和其他原因特异性生存期（OCSS）。分析方法包括倾向评分匹配（PSM）、Kaplan-Meier生存曲线和Cox比例风险建模。
共确定2775例mRCC患者，其中134例（4.8%）接受PN，2641例（95.2%）接受RN。PN组患者更常被诊断为较低的T分期、较低的分级、N0以及非透明细胞RCC，而RN组患者肺转移发生率较高。在1:2倾向评分匹配后，两组之间的OS、DSS和OCSS无显著差异。进一步的亚组分析表明，PN可能有助于延长T1和N0期mRCC患者的OS，而N1期mRCC患者可能从RN中获益更多。
在免疫治疗时代，PN可为mRCC患者提供与RN相当的生存获益。然而，术前分期和风险分层是必要的，因为不同T或N分期组的mRCC预后有所不同。
