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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 704-710. doi: 10.19723/j.issn.1671-167X.2025.04.012

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

Zezhen ZHOU, Liyuan GE, Fan ZHANG, Shaohui DENG, Ye YAN, Hongxian ZHANG, Guoliang WANG, Lei LIU, Yi HUANG, Shudong ZHANG*()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2025-02-28 Online:2025-08-18 Published:2025-08-02
  • Contact: Shudong ZHANG
  • Supported by:
    the Beijing Health Technology Achievements and Appropriate Technology Promotion Project(BHTPP2024003)

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Abstract:

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.

Key words: Renal cell carcinoma, Partial nephrectomy, Radical nephrectomy, Pathological T3a

CLC Number: 

  • R737.11

Table 1

Baseline of patients undergoing PN and RN before and after propensity score matching"

Items Before propensity score matching P value After propensity score matching Pvalue
PN (n = 33) RN (n = 394) PN (n = 33) RN (n = 33)
Age/years, n(%) 0.879 >0.999
    ＜65 18 (54.5) 203 (51.5) 18 (54.5) 18 (54.5)
    ≥ 65 15 (45.5) 191 (48.5) 15 (45.5) 15 (45.5)
Gender, n(%) 0.164 ＞0.999
    Male 26 (78.8) 257 (65.2) 26 (78.8) 27 (81.8)
    Female 7 (21.2) 137 (34.8) 7 (21.2) 6 (18.2)
Laterality, n(%) ＞0.999 0.460
    Left 18 (54.5) 215 (54.6) 18 (54.5) 14 (42.4)
    Right 15 (45.5) 179 (45.4) 15 (45.5) 19 (57.6)
ASA level, n(%) 0.146 0.920
    1 6 (18.2) 82 (20.8) 6 (18.2) 7 (21.2)
    2 25 (75.8) 291 (73.9) 25 (75.8) 23 (69.7)
    3 1 (3.0) 20 (5.1) 1 (3.0) 2 (6.1)
    4 1 (3.0) 1 (0.3) 1 (3.0) 1 (3.0)
Comorbidity, n(%) 14 (42.4) 166 (42.1) ＞0.999 14 (42.4) 17 (51.5) 0.622
Hypertension 14 (42.4) 141 (35.8) 14 (42.4) 14 (42.4)
Diabetes 6 (18.2) 52 (13.2) 6 (18.2) 9 (27.3)
CHD 1 (3.0) 21 (5.3) 1 (3.0) 2 (6.1)
CVD 2 (6.1) 21 (5.3) 2 (6.1) 1 (3.0)
Surgery history 12 (36.4) 104 (26.4) 12 (36.4) 11 (33.3)
Tumor diameter /cm, n(%) ＜0.001 >0.999
    ≤4 26 (78.8) 61 (15.5) 26 (78.8) 26 (78.8)
    >4, ≤7 7 (21.2) 202 (51.3) 7 (21.2) 7 (21.2)
    >7 0 (0) 131 (33.2) 0 (0) 0 (0)
eGFR/ [mL/(min·1.73 m2)], M (P25, P75) 88.9
(64.0, 99.3)		 86.7
(72.6, 97.6)		 0.956 88.9
(64.0, 99.3)		 89.3
(79.6, 97.7)		 0.830
Renal vein thrombosis, n(%) 0 (0) 60 (15.2) 0.031 0 (0) 0 (0) >0.999
PFI, n(%) 15 (45.5) 60 (15.2) ＜0.001 15 (45.5) 16 (48.5) ＞0.999
RSI, n(%) 7 (21.2) 290 (73.6) ＜0.001 10 (30.3) 12 (36.4) 0.794
Segmental renal vein extension, n(%) 14 (42.4) 82 (20.8) 0.008 14 (42.4) 15 (45.5) ＞0.999
Histology, n(%) ＞0.999 >0.999
    ccRCC 29 (87.9) 346 (87.8) 29 (87.9) 29 (87.9)
    nccRCC 4 (12.1) 48 (12.2) 4 (12.1) 4 (12.1)
Fuhrman grading, n(%) 0.072 0.782
    Ⅰ-Ⅱ 25 (75.8) 229 (58.1) 25 (75.8) 23 (69.7)
    Ⅲ-Ⅳ 8 (24.2) 165 (41.9) 8 (24.2) 10 (30.3)
Sarcomatoid differentiation, n(%) 0 (0) 9 (2.3) ＞0.999 0 (0) 0 (0) >0.999

Table 2

Comparison of perioperative outcomes of PN group and RN group in the matched cohort"

Items PN (n=33) RN (n=33) P value
Nephrectomy techniques, n(%) 0.672
    Laparoscopic nephrectomy 29 (87.9) 31 (93.9)
    Robot-assisted laparoscopic nephrectomy 4 (12.1) 2 (6.1)
Surgical approach, n(%) 0.622
    Retroperitoneal 15 (45.5) 18 (54.5)
    Transperitoneal 18 (54.5) 15 (45.5)
Open conversion, n(%) 1 (3.0) 3 (9.1) 0.613
Operative time/min, ${\bar x}$±s 159.0±57.8 148.0±70.8 0.281
Blood loss/mL, M (P25, P75) 50.0 (20, 100) 20.0 (20, 50) 0.372
Postoperative eGFR [mL/(min·1.73m2], M (P25, P75) 76.9 (55.4, 87.3) 61.7 (56.8, 73.5) 0.016
Complications, n(%) 6 (18.2) 8 (24.2) 0.763
PSM, n(%) 1 (3.3) 0 (0) ＞0.999
Postoperative hospital stays/d，${\bar x}$±s 6.1±2.4 5.9±2.1 0.818

Figure 1

Oncological outcomes of PN group and RN group in the matched cohort A, overall survival; B, cancer-specific survival; C, disease-free survival of patients with pT3a stage renal cell carcinoma in the matched cohort. PN, partial nephrectomy; RN, radical nephrectomy; pT3a, pathological T3a."

Figure 2

Multivariate Cox regression analysis of DFS and CSS in patients with pT3a RCC DFS, disease-free survival; CSS, cancer-specific survival; PN, partial nephrectomy; RN, radical nephrectomy; RVI, renal vein invasion; ccRCC, clear cell renal cell carcinoma; nccRCC, non-clear cell renal cell carcinoma; pT3a, pathological T3a; RCC, renal cell carcinoma."

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