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. 2025 Aug 18;57(4):704-710.
doi: 10.19723/j.issn.1671-167X.2025.04.012.

[A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma]

[Article in Chinese]
Z Zhou  1 , L Ge  1 , F Zhang  1 , S Deng  1 , Y Yan  1 , H Zhang  1 , G Wang  1 , L Liu  1 , Y Huang  1 , S Zhang  1
Affiliations

[A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma]

[Article in Chinese]
Z Zhou et al. Beijing Da Xue Xue Bao Yi Xue Ban. .

Abstract
in English, Chinese

Objective: 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.

Methods: 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.

Results: Before matching, the PN group (n = 33) had significantly higher rates of perirenal fat invasion (PFI, 45.5% vs. 15.2%) and segmental renal vein involvement (42.4% vs. 20.8%), but lower rates of renal sinus invasion (RSI, 21.2% vs. 73.6%) and renal vein tumor thrombus (0% vs. 15.2%) compared with the RN group (n = 394, all P < 0.05). After matching, baseline characteristics were comparable between the PN group (n = 33) and RN group (n = 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 (P > 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 m2) vs. 61.7 (56.8, 73.5) mL/(min·1.73 m2), P < 0.05], indicating better renal function preservation. No significant differences were found in OS, CSS, or DFS between the groups (P > 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 (P < 0.05).

Conclusion: 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.

目的: 评估临床T1(clinical T1，cT1)期术后升级为病理T3a(pathological T3a，pT3a)期肾细胞癌(renal cell carcinoma，RCC) 患者应用肾部分切除术(partial nephrectomy，PN)的远期肿瘤学结局。

方法: 回顾研究北京大学第三医院2013年2月至2022年12月427例术后评估为pT3aN0M0期的RCC患者，其中33例cT1术后升级为pT3a的RCC患者均接受了PN(PN组)，而394例术后未升级的pT3a RCC患者均接受了根治性肾切除术(radical nephrectomy，RN，RN组)，根据基线特征以1 ∶ 1的比例进行倾向性评分匹配，使用Kalan-Meier曲线评估总生存期(overall survival, OS)、癌症特异性生存期(cancer-specific survival, CSS)和无病生存期(disease-free survival, DFS)，并使用对数秩检验和Cox回归模型进行多因素分析。

结果: 匹配前，PN组(n = 33)与RN组(n = 394)相比，肾周脂肪浸润(perirenal fat invasion，PFI; 45.5% vs. 15.2%)和肾段静脉受累(42.4% vs. 20.8%)的比例更高，而肾盂肾窦侵犯(renal sinus invasion，RSI; 21.2% vs. 73.6%)及合并肾静脉癌栓(0% vs. 15.2%)的比例较低，差异有统计学意义(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。PN和RN组在手术时间、出血量、平均住院日、并发症发生率、阳性切缘率、中转开放手术的比例方面差异无统计学意义(P ＞0.05)，但PN组术后估算的肾小球滤过率(estimated glomerular filtration rate，eGFR)更高[76.9 (55.4，87.3) mL/(min·1.73 m2) vs. 61.7 (56.8，73.5) mL/(min·1.73 m2)，P < 0.05]，表明其对肾功能的保留效果更好。两组在OS、CSS和DFS方面差异无统计学意义(P ＞0.05)。多因素分析显示，肾静脉侵犯(renal vein invasion，RVI)、较高的肿瘤Fuhrman分级(Ⅲ~Ⅳ)以及伴有肉瘤样分化特征是pT3a RCC患者的DFS和CSS的独立危险因素(P < 0.05)。

结论: 对于cT1升级为pT3a的RCC患者，PN在更大程度上保留了肾功能，并且肿瘤学结局可能与RN的效果相当。RVI、较高的肿瘤Fuhrmann分级以及伴有肉瘤样分化特征是pT3N0M0期RCC患者的独立危险因素。

Keywords: Partial nephrectomy; Pathological T3a; Radical nephrectomy; Renal cell carcinoma.

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Conflict of interest statement

利益冲突 所有作者声明不存在利益冲突。

Figures

图 1
图 1
匹配后队列中PN组和RN组的肿瘤学结局 Oncological outcomes of PN group and RN group in the matched cohort
图 2
图 2
pT3a RCC患者DFS和CSS的多因素Cox回归分析 Multivariate Cox regression analysis of DFS and CSS in patients with pT3a RCC
See this image and copyright information in PMC

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