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 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,...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12957-024-03302-y |
| _version_ | 1797276483736043520 |
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| author | Haozhe Xu Zhuo Xing Kai Ai Jie Wang Zhengtong Lv Haitao Deng Ke Li Yang Wang Yuan Li |
| author_facet | Haozhe Xu Zhuo Xing Kai Ai Jie Wang Zhengtong Lv Haitao Deng Ke Li Yang Wang Yuan Li |
| author_sort | Haozhe Xu |
| collection | DOAJ |
| description | 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). |
| first_indexed | 2024-03-07T15:29:49Z |
| format | Article |
| id | doaj.art-80571afb756f4c9b916ab7f7dfa4e6fb |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-03-07T15:29:49Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-80571afb756f4c9b916ab7f7dfa4e6fb2024-03-05T16:31:47ZengBMCWorld Journal of Surgical Oncology1477-78192024-01-0122111110.1186/s12957-024-03302-yPatients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity scoreHaozhe Xu0Zhuo Xing1Kai Ai2Jie Wang3Zhengtong Lv4Haitao Deng5Ke Li6Yang Wang7Yuan Li8Department of Urology, The Second Xiangya Hospital, Central South UniversityDepartment of Urology, The Second Xiangya Hospital, Central South UniversityDepartment of Urology, The Second Xiangya Hospital, Central South UniversityDepartment of Oncology, Hunan Cancer HospitalDepartment of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesDepartment of Urology, The Second Xiangya Hospital, Central South UniversityDepartment of Urology, Xiangya Hospital, Central South UniversityDepartment of Pathology, The Second Xiangya Hospital, Central South UniversityDepartment of Urology, The Second Xiangya Hospital, Central South UniversityAbstract 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).https://doi.org/10.1186/s12957-024-03302-yClear cell renal cell carcinomaNuclear gradeOverlap weightingPartial nephrectomy |
| spellingShingle | Haozhe Xu Zhuo Xing Kai Ai Jie Wang Zhengtong Lv Haitao Deng Ke Li Yang Wang Yuan Li Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score World Journal of Surgical Oncology Clear cell renal cell carcinoma Nuclear grade Overlap weighting Partial nephrectomy |
| title | Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score |
| title_full | Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score |
| title_fullStr | Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score |
| title_full_unstemmed | Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score |
| title_short | Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score |
| title_sort | patients with high nuclear grade pt1 ccrcc are more suitable for radical nephrectomy than partial nephrectomy a multicenter retrospective study using propensity score |
| topic | Clear cell renal cell carcinoma Nuclear grade Overlap weighting Partial nephrectomy |
| url | https://doi.org/10.1186/s12957-024-03302-y |
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