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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 667-672. doi: 10.19723/j.issn.1671-167X.2024.04.020

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Functional and oncologic outcomes of partial nephrectomy for cystic renal cell carcinoma: A single-center retrospective study

Fan SHU,Yichang HAO,Zhanyi ZHANG,Shaohui DENG,Hongxian ZHANG,Lei LIU,Guoliang WANG,Xiaojun TIAN,Lei ZHAO,Lulin MA,Shudong ZHANG*()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-03-14 Online:2024-08-18 Published:2024-07-23
  • Contact: Shudong ZHANG E-mail:zhangshudong@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82273389);the Natural Science Foundation of Beijing(7232212)

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Abstract:

Objective: To investigate the postoperative renal function and oncologic outcomes of cystic renal cell carcinoma with partial nephrectomy, and to compared the single-center data on surgical outcomes with the Surveillance, Epidemiology, and End Results (SEER) database. Methods: This was a retrospective study that included the patients with cystic renal cell carcinoma who underwent partial nephrectomy in the Department of Urology, Peking University Third Hospital (PUTH) from 2010 to 2023. The clinical data and depicting baseline characteristics were collected. Renal dynamic imaging and the Chinese Coefficients for Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formulae were used to calculate the estimated glomerular filtration rate (eGFR). The renal function curves over time were then plotted, and the patients were followed-up to record their survival status. Cases of cystic renal cell carcinoma in the SEER database between 2000 and 2020 were included, propensity score matching (PSM) was performed to balance the differences between SEER cohort and PUTH cohort, and the cancer-specific survival (CSS) curves for both groups were plotted and statistical differences were calculated by the Kaplan-Meier method. Results: A total of 38 and 385 patients were included in the PUTH cohort and SEER cohort, respectively, and 31 and 72 patients were screened in each cohort after PSM. Of the baseline characteristics, only tumor size (P=0.042) was found to differ statistically between the two groups. There was no statistically significant difference between the two cohorts in terms of CSS after PSM (P=0.556). The median follow-up time in the SEER cohort was 112.5 (65, 152) months and a 10-year survival rate of 97.2%, while the PUTH cohort had a median follow-up of 57.0 (20, 1 172) months and a 10-year survival rate of 100.0%. There was no statistically significant difference between eGFR determined by preoperative renal dynamic imaging and the results of the C-CKD-EPI formulae based on creatinine estimation (P=0.073). There was a statistically significant difference in eGFR among the preoperative, short-term postoperative, and long-term postoperative (P < 0.001), which was characterized by the presence of a decline in renal function in the short-term postoperative period and the recovery of renal function in the long-term period. Conclusion: Partial nephrectomy for cystic renal cell carcinoma is safe and feasible with favorable renal function and oncologic outcomes.

Key words: Cystic renal cell carcinoma, Partial nephrectomy, Oncological outcome, Kidney function tests

CLC Number: 

  • R737.11

Table 1

Baseline data and clinical characteristics of 38 patients with cystic renal carcinoma in the PUTH cohort"

Variables Total (n=38)
Stay time/d 6 (5, 8)
BMI/(kg/m2) 24.93±4.42
Extubation time/d 5 (3, 6)
HGB change/(g/L) -20.42±11.38
Albumin/(g/dL) 43.66±3.69
eGFR-trouble side/(mL/min) 45.32±12.02
OT/min 144.00 (123.25, 199.75)
WIT/min 21.50 (15.25, 26.00)
EBL/mL 22.50 (12.50, 100.00)
Hypertension
  No 31 (81.6)
  Yes 7 (18.4)
Diabetes
  No 35 (92.1)
  Yes 3 (7.9)
Surgical history
  No 27 (71.1)
  Yes 11 (28.9)
Surgical option
  Laparoscope 33 (86.8)
  Robot-assisted 4 (10.5)
  Open 1 (2.6)
Approach
  Retroperitoneal 23 (60.5)
  Transperitoneal 15 (39.5)
Anteroposterior location
  Anterior 20 (52.6)
  Posterior 13 (34.2)
  Neither 5 (13.2)
Longitudinal location
  Upper pole 11 (28.9)
  Middle pole 10 (26.3)
  Lower pole 17 (44.7)
Perirenal fat invasion
  No 34 (89.5)
  Yes 4 (10.5)
ASA grade
  1 21 (55.3)
  2 15 (39.5)
  3 2 (5.3)
Complication
  No 36 (94.7)
  Yes 2 (5.3)
Adjuvant therapy
  No 32 (84.2)
  Yes 6 (15.8)

Table 2

Comparison of baseline characteristics between SEER cohort and PUTH cohort before and after PSM"

VariablesBefore PSM After PSM
SEER cohort (n=385) PUTH cohort (n=38) P value SEER cohort (n=72) PUTH cohort (n=31) P value
Age/years 56.60±12.39 48.24±13.55 ＜0.001 50.26±12.14 51.55±11.41 0.617
Tumor size/cm 28.71±18.93 50.26±23.52 ＜0.001 37.19±21.57 46.87±22.70 0.042
Gender 0.358 0.794
  Male 218 (56.6) 25 (65.8) 50 (69.4) 20 (64.5)
  Female 167 (43.4) 13 (34.2) 22 (30.6) 11 (35.5)
Laterality 0.629 0.533
  Left 183 (47.5) 21 (55.3) 33 (45.8) 17 (54.8)
  Right 202 (52.5) 17 (44.7) 39 (54.2) 14 (45.2)
T stage ＜0.001 0.126
  1a 309 (80.3) 16 (42.1) 48 (66.7) 15 (48.4)
  1b 51 (13.2) 8 (21.1) 15 (20.8) 6 (19.4)
  2a 11 (2.9) 10 (26.3) 5 (6.9) 6 (19.4)
  2b 2 (0.5) 0 (0) 1 (1.4) 0 (0)
  3a 12 (3.1) 4 (10.5) 3 (4.2) 4 (12.9)
N stage 0.555 0.434
  0 373 (96.9) 38 (100.0) 68 (94.4) 31 (100.0)
  x 12 (3.1) 0 (0) 4 (5.6) 0 (0)
M stage 0.006 0.252
  0 383 (99.5) 37 (97.4) 71 (98.6) 30 (96.8)
  1 0 (0) 1 (2.6) 0 (0) 1 (3.2)
  x 2 (0.5) 0 (0) 1 (1.4) 0 (0)

Figure 1

Kaplan-Meier analysis of CSS in SEER cohort and PUTH cohort after PSM CSS, cancer-specific survival; SEER, the Surveillance, Epidemiology, and End Results. PUTH, Peking University Third Hospital; PSM, propensity score matching."

Figure 2

Line chart of eGFR change before and after operation in the PUTH cohort *, P < 0.05; * * *, P < 0.001; ns, P>0.05. eGFR, estimated glomerular filtration rate; C-CKD-EPI, Chinese coefficients for chronic kidney disease epidemiology collaboration; PUTH, Peking University Third Hospital."

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