Yudong Cao, Yushuang Cui, Ruojing Li, Xingxing Tang, Chen Lin, Xiao Yang, Jia Liu, Qiang Zhao, Jinchao Ma, Artur de Oliveira Paludo, Benjamin N Schmeusser, Shuo Wang, Peng Du
{"title":"比较T1期肾癌部分切除（PN）与根治性肾切除术（RN）的远期预后及肾功能变化。","authors":"Yudong Cao, Yushuang Cui, Ruojing Li, Xingxing Tang, Chen Lin, Xiao Yang, Jia Liu, Qiang Zhao, Jinchao Ma, Artur de Oliveira Paludo, Benjamin N Schmeusser, Shuo Wang, Peng Du","doi":"10.21037/tau-2025-136","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radical nephrectomy (RN) and partial nephrectomy (PN) are common surgical treatments for T1 stage renal cell carcinoma (RCC). However, the long-term impact of these surgical approaches on prognosis and renal function remains an area of ongoing investigation. This study compared the effects of these procedures on prognosis and renal function.</p><p><strong>Methods: </strong>The data of 1,030 T1 stage RCC patients treated at Peking University Cancer Hospital & Institute between January 2014 and August 2022 were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). The secondary endpoints included the annual mean estimated glomerular filtration rate (eGFR) and the average annual eGFR change rates.</p><p><strong>Results: </strong>Based on a median follow-up time of 57 months, the OS and CSS rates were 96.6% and 98.5% in the overall cohort, respectively. The multivariate analysis identified age [hazard ratio (HR), 2.664; 95% confidence interval (CI): 1.147-6.192; P=0.02], tumor grade (HR, 2.247; 95% CI: 1.050-4.810; P=0.04), and surgical approach (HR, 2.585; 95% CI: 1.056-6.325; P=0.04) as adverse prognostic factors for OS, and age (HR, 4.603; 95% CI: 1.035-20.471; P=0.045) and tumor grade (HR, 4.972; 95% CI: 1.752-14.111; P=0.003) as adverse prognostic factors for CSS. Throughout the follow-up period, the eGFR of the RN patients showed a gradual increase, while that of the PN patients remained stable (P<0.001). Among the patients with preoperative diabetes, the eGFR of the RN patients decreased significantly compared to that of the PN patients (P=0.03).</p><p><strong>Conclusions: </strong>T1 stage RCC has a favorable prognosis with surgery, and PN is an oncologically safe option. A persistent eGFR difference was observed between the PN and RN groups, with RN showing a gradual upward trend. However, patients with pre-existing diabetes experienced a greater decline in renal function after RN, which highlights the advantages of PN for such patients.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"14 3","pages":"740-750"},"PeriodicalIF":1.7000,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986548/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparing the long-term prognosis and renal function changes of partial nephrectomy (PN) and radical nephrectomy (RN) in T1 stage renal cell carcinoma patients.\",\"authors\":\"Yudong Cao, Yushuang Cui, Ruojing Li, Xingxing Tang, Chen Lin, Xiao Yang, Jia Liu, Qiang Zhao, Jinchao Ma, Artur de Oliveira Paludo, Benjamin N Schmeusser, Shuo Wang, Peng Du\",\"doi\":\"10.21037/tau-2025-136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radical nephrectomy (RN) and partial nephrectomy (PN) are common surgical treatments for T1 stage renal cell carcinoma (RCC). However, the long-term impact of these surgical approaches on prognosis and renal function remains an area of ongoing investigation. This study compared the effects of these procedures on prognosis and renal function.</p><p><strong>Methods: </strong>The data of 1,030 T1 stage RCC patients treated at Peking University Cancer Hospital & Institute between January 2014 and August 2022 were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). The secondary endpoints included the annual mean estimated glomerular filtration rate (eGFR) and the average annual eGFR change rates.</p><p><strong>Results: </strong>Based on a median follow-up time of 57 months, the OS and CSS rates were 96.6% and 98.5% in the overall cohort, respectively. The multivariate analysis identified age [hazard ratio (HR), 2.664; 95% confidence interval (CI): 1.147-6.192; P=0.02], tumor grade (HR, 2.247; 95% CI: 1.050-4.810; P=0.04), and surgical approach (HR, 2.585; 95% CI: 1.056-6.325; P=0.04) as adverse prognostic factors for OS, and age (HR, 4.603; 95% CI: 1.035-20.471; P=0.045) and tumor grade (HR, 4.972; 95% CI: 1.752-14.111; P=0.003) as adverse prognostic factors for CSS. Throughout the follow-up period, the eGFR of the RN patients showed a gradual increase, while that of the PN patients remained stable (P<0.001). Among the patients with preoperative diabetes, the eGFR of the RN patients decreased significantly compared to that of the PN patients (P=0.03).</p><p><strong>Conclusions: </strong>T1 stage RCC has a favorable prognosis with surgery, and PN is an oncologically safe option. A persistent eGFR difference was observed between the PN and RN groups, with RN showing a gradual upward trend. However, patients with pre-existing diabetes experienced a greater decline in renal function after RN, which highlights the advantages of PN for such patients.</p>\",\"PeriodicalId\":23270,\"journal\":{\"name\":\"Translational andrology and urology\",\"volume\":\"14 3\",\"pages\":\"740-750\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-03-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986548/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational andrology and urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tau-2025-136\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ANDROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational andrology and urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tau-2025-136","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/26 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ANDROLOGY","Score":null,"Total":0}
Comparing the long-term prognosis and renal function changes of partial nephrectomy (PN) and radical nephrectomy (RN) in T1 stage renal cell carcinoma patients.
Background: Radical nephrectomy (RN) and partial nephrectomy (PN) are common surgical treatments for T1 stage renal cell carcinoma (RCC). However, the long-term impact of these surgical approaches on prognosis and renal function remains an area of ongoing investigation. This study compared the effects of these procedures on prognosis and renal function.
Methods: The data of 1,030 T1 stage RCC patients treated at Peking University Cancer Hospital & Institute between January 2014 and August 2022 were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). The secondary endpoints included the annual mean estimated glomerular filtration rate (eGFR) and the average annual eGFR change rates.
Results: Based on a median follow-up time of 57 months, the OS and CSS rates were 96.6% and 98.5% in the overall cohort, respectively. The multivariate analysis identified age [hazard ratio (HR), 2.664; 95% confidence interval (CI): 1.147-6.192; P=0.02], tumor grade (HR, 2.247; 95% CI: 1.050-4.810; P=0.04), and surgical approach (HR, 2.585; 95% CI: 1.056-6.325; P=0.04) as adverse prognostic factors for OS, and age (HR, 4.603; 95% CI: 1.035-20.471; P=0.045) and tumor grade (HR, 4.972; 95% CI: 1.752-14.111; P=0.003) as adverse prognostic factors for CSS. Throughout the follow-up period, the eGFR of the RN patients showed a gradual increase, while that of the PN patients remained stable (P<0.001). Among the patients with preoperative diabetes, the eGFR of the RN patients decreased significantly compared to that of the PN patients (P=0.03).
Conclusions: T1 stage RCC has a favorable prognosis with surgery, and PN is an oncologically safe option. A persistent eGFR difference was observed between the PN and RN groups, with RN showing a gradual upward trend. However, patients with pre-existing diabetes experienced a greater decline in renal function after RN, which highlights the advantages of PN for such patients.
期刊介绍：
ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.
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