Evolving trends and clinical-pathological correlations in renal cell carcinoma surgery: a decade-long study at Peking University First Hospital

Abstract

This study aimed to comprehensively delineate the clinical characteristics, surgical interventions, and evolving trends over the past decade among patients undergoing surgery for renal cell carcinoma (RCC). A retrospective analysis was conducted on the clinical records of 9,110 patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital between January 2013 and December 2022. Statistical analyses were performed using SPSS 21.0 software. Categorical variables were analyzed using the Chi-square test or Fisher's exact test, as appropriate. Numerical variables were assessed using the t-test or analysis of variance (ANOVA) for normally distributed data, while nonparametric tests were employed for non-normally distributed numerical variables or ordinal data. A p-value of less than 0.05 was considered statistically significant. The study cohort consisted of 6,416 males (70.4%) and 2,694 females (29.6%), with a median age of 55 years. Clear cell renal cell carcinoma (ccRCC) was the most prevalent histological subtype (87.6%), followed by chromophobe renal cell carcinoma (chRCC) (5.1%), papillary renal cell carcinoma (pRCC) (3.7%), and other subtypes (3.6%). Non-ccRCC patients exhibited a significantly higher proportion of advanced T3 + disease staging (19.4% vs. 15%, P < 0.001). Female patients demonstrated higher incidences of both non-ccRCC and special pathology types (P < 0.001), while non-ccRCC and advanced T-stage disease were more common in pediatric patients (P < 0.001) and were more likely to undergo radical nephrectomy (P < 0.001). Over the span of a decade, the demographic characteristics of RCC patients remained relatively stable; however, there was a notable decrease in tumor size over time (P < 0.001). Notably, partial nephrectomy rates surged between 2013 and 2016-reflecting growing acceptance of nephron-sparing techniques-but later balanced with radical nephrectomies as stricter selection criteria emerged, highlighting the dynamic evolution of RCC surgical management. Our study reveals dynamic shifts in RCC management over the past decade, marked by evolving surgical practices and a trend toward smaller tumor sizes at diagnosis, while distinct clinical features in pediatric patients underscore the need for continued refinement of early detection.

Keywords: Renal cell carcinoma; Surgery; Pathology; Decade-long study.

Fig. 1

Patients’ geographic area distribution

Fig. 2

Trends in the number of surgical operations for RCC patients

Fig. 3

Trends in the age of RCC patients. * RCC, renal cell carcinoma; PSM, positive surgical margin

Fig. 4

Trends in the surgical approaches of RCC patients

Fig. 5

Trends in the surgical modalities of RCC patients

Fig. 6

Trends in the T stages of RCC patients

Fig. 7

Trends in the tumor diameters of RCC patients

Fig. 8

Trends in the pathological classifications of RCC patients

Fig. 9

Trends in the positive surgical margin rates of RCC patients