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World Journal of Surgical Oncology

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Open Access 01-12-2024 | Nephrectomy | Research

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

Authors: Haozhe Xu, Zhuo Xing, Kai Ai, Jie Wang, Zhengtong Lv, Haitao Deng, Ke Li, Yang Wang, Yuan Li

Published in: World Journal of Surgical Oncology | Issue 1/2024

Abstract

Background

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.

Methods

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).

Results

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 < 0.05), G3 subset (HR = 0.097, 95% CI 0.021–0.455; p < 0.05), and G4 subset (HR = 0.091, 95% CI 0.011–0.736; p < 0.05), and resulting in increased five-year local recurrence-free survival rates of 7.0%, 17.9%, and 36.2%, respectively. An association between RN and a reduced risk of distant metastases in the G4 subset (HR = 0.071, 95% CI 0.016–0.325; p < 0.05), with the five-year distant metastases-free survival rate increasing by 33.1% was also observed. No significant difference in ACM between PN and RN was identified.

Conclusions

Our findings substantiate that opting for RN, as opposed to PN, is more advantageous for local recurrence-free survival and distant metastases-free survival in patients with high nuclear grade (especially G4) pT1-ccRCC. We recommend placing a heightened emphasis on enhancing preoperative nuclear grade assessment, as it can significantly influence the choice of surgical plan.

Trial registration

This study was registered at Chinese Clinical Trial Registry (ID: ChiCTR2200063333).

Available only for authorised users

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Title: Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score
Authors: Haozhe Xu
Zhuo Xing
Kai Ai
Jie Wang
Zhengtong Lv
Haitao Deng
Ke Li
Yang Wang
Yuan Li
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Nephrectomy
Nephrectomy
Nephrectomy
Kidney Cancer
Kidney Cancer
Kidney Cancer
Metastasis
Published in: World Journal of Surgical Oncology / Issue 1/2024
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-024-03302-y

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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