Zhou Z, Ge L, Zhang F, Deng S, Yan Y, Zhang H, Wang G, Liu L, Huang Y, Zhang S
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):704-710. doi: 10.19723/j.issn.1671-167X.2025.04.012.
To evaluate the long-term oncological outcomes of partial nephrectomy (PN) in patients with renal cell carcinoma (RCC) who were clinically staged as clinical T1 (cT1) preoperatively but upstaged to pathological T3a (pT3a) after surgery.
A total of 427 RCC patients postoperatively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed. Among them, 33 cT1 patients upstaged to pT3a RCC received PN (PN group), while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy (RN, RN group). Propensity score matching was performed at a 1 ∶ 1 ratio based on baseline characteristics. The Kaplan-Meier method was used to assess overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS), with Log-rank tests and Cox regression models for multivariate analysis.
Before matching, the PN group ( = 33) had significantly higher rates of perirenal fat invasion (PFI, 45.5% . 15.2%) and segmental renal vein involvement (42.4% . 20.8%), but lower rates of renal sinus invasion (RSI, 21.2% . 73.6%) and renal vein tumor thrombus (0% . 15.2%) compared with the RN group ( = 394, all < 0.05). After matching, baseline characteristics were comparable between the PN group ( = 33) and RN group ( = 33). No significant differences were observed in operative time, blood loss, mean hospital stay, complication rate, positive margin rate, or conversion to open surgery between the two groups ( > 0.05). However, the PN group showed significantly higher estimated glomerular filtration rate (eGFR) postoperatively [76.9 (55.4, 87.3) mL/(min·1.73 m) . 61.7 (56.8, 73.5) mL/(min·1.73 m), < 0.05], indicating better renal function preservation. No significant differences were found in OS, CSS, or DFS between the groups ( > 0.05). Multivariate ana-lysis identified renal vein invasion (RVI), higher Fuhrman grades (Ⅲ-Ⅳ), and sarcomatoid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients ( < 0.05).
For cT1 RCC patients upstaged to pT3a, PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN. RVI, higher Fuhrmann grade, and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.
评估术前临床分期为临床T1（cT1）但术后病理分期为病理T3a（pT3a）的肾细胞癌（RCC）患者行肾部分切除术（PN）的长期肿瘤学结局。
回顾性分析2013年2月至2022年12月在北京大学第三医院术后诊断为pT3aN0M0的427例RCC患者。其中，33例cT1期患者术后病理分期上调为pT3a期RCC接受了PN（PN组），而394例未上调分期的pT3a期RCC患者接受了根治性肾切除术（RN，RN组）。根据基线特征以1∶1的比例进行倾向评分匹配。采用Kaplan-Meier法评估总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS），并使用Log-rank检验和Cox回归模型进行多因素分析。
匹配前，PN组（n = 33）肾周脂肪浸润（PFI，45.5% 对15.2%）和节段性肾静脉受累（42.4% 对20.8%）的发生率显著高于RN组（n = 394，均P < 0.05），但肾窦侵犯（RSI，21.2% 对73.6%）和肾静脉肿瘤血栓（0% 对15.2%）的发生率低于RN组（均P < 0.05）。匹配后，PN组（n = 33）和RN组（n = 33）的基线特征具有可比性。两组在手术时间、失血量、平均住院时间、并发症发生率、切缘阳性率或转为开放手术方面均未观察到显著差异（P > 0.05）。然而，PN组术后的估计肾小球滤过率（eGFR）显著更高[76.9（55.4，87.3）mL/（min·1.73 m²）对·61.7（56.8，73.5）mL/（min·1.73 m²），P < 0.05]，表明肾功能保留更好。两组在OS、CSS或DFS方面均未发现显著差异（P > 0.05）。多因素分析确定肾静脉侵犯（RVI）、较高的Fuhrman分级（Ⅲ-Ⅳ级）和肉瘤样分化是 pT3a期RCC患者DFS和CSS的独立危险因素（P < 0.05）。
对于上调分期为pT3a的cT1期RCC患者，PN在实现与RN相当的肿瘤学结局的同时，更有效地保留了肾功能。RVI、较高的Fuhrmann分级和肉瘤样分化是pT3N0M0期RCC患者的独立危险因素。
