Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score

Partial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patien...

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Bibliographic Details
Published in:World journal of surgical oncology 2024-01, Vol.22 (1), p.24-11, Article 24
Main Authors: Xu, Haozhe, Xing, Zhuo, Ai, Kai, Wang, Jie, Lv, Zhengtong, Deng, Haitao, Li, Ke, Wang, Yang, Li, Yuan
Format: Article
Language:English
Subjects:
Cancer
Carcinoma
Carcinoma, Renal cell
Carcinoma, Renal Cell - surgery
Care and treatment
Clear cell renal cell carcinoma
Clear cell-type renal cell carcinoma
Development and progression
Diagnosis
Humans
Kidney cancer
Kidney Neoplasms - surgery
Medical prognosis
Metastases
Metastasis
Nephrectomy
Nuclear grade
Overlap weighting
Partial nephrectomy
Patient outcomes
Patients
Propensity Score
Regression analysis
Regression models
Relapse
Retrospective Studies
Risk management
Surgeons
Surgery
Survival
Survival analysis
Variables
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Summary:Partial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patients with high nuclear grades treated with PN had poorer prognosis compared with those treated with radical nephrectomy (RN). Therefore, this study was designed to evaluate the associations of PN and RN in the four nuclear grade subsets with oncologic outcomes. A retrospective study was conducted in three Chinese urological centers that included 1,714 patients who underwent PN or RN for sporadic, unilateral, pT1, N0, and M0 ccRCC without positive surgical margins and neoadjuvant therapy between 2010 and 2019. Associations of nephrectomy type with local ipsilateral recurrence, distant metastases, and all-cause mortality (ACM) were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazards regression models after overlap weighting (OW). A total of 1675 patients entered the OW cohort. After OW, in comparison to PN, RN associated with a reduced risk of local ipsilateral recurrence in the G2 subset (HR = 0.148, 95% CI 0.046-0.474; p 
ISSN:1477-7819
1477-7819
DOI:10.1186/s12957-024-03302-y