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Xu H, Xing Z, Ai K, Wang J, Lv Z, Deng H, Li K, Wang Y, Li Y. Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score. World J Surg Oncol 2024; 22:24. [PMID: 38254091 PMCID: PMC10804783 DOI: 10.1186/s12957-024-03302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
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).
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Affiliation(s)
- Haozhe Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhuo Xing
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Kai Ai
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Jie Wang
- Department of Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Haitao Deng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Ke Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Wang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Tang Y, Shao Y, Hu X, Ren S, Li X. Prognostic value of preoperative microscopic hematuria in patients with non-metastatic renal cell carcinoma who underwent nephrectomy. J Cancer Res Clin Oncol 2023; 149:13545-13552. [PMID: 37498397 DOI: 10.1007/s00432-023-05204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Microscopic hematuria is associated with various urinary system diseases and is commonly used for the diagnosis of these conditions. Its prognostic role in non-metastatic renal cell carcinoma (RCC) patients who underwent nephrectomy remains unclear. PATIENTS AND METHODS A retrospective analysis of non-metastatic RCC patients who underwent nephrectomy in West China Hospital of Sichuan University from 2011 to 2013 was performed. Significant microscopic hematuria (SMH), defined as a threshold with a significant impact on disease-free survival (DFS) and overall survival (OS), was determined by Kaplan-Meier curves and the Maximally Selected Log-Rank Statistic. Kaplan-Meier curves were then used to estimate patients' DFS and OS, and the log-rank test was used to examine statistical significance. Logistic regression was utilized to identify clinical-pathological factors associated with SMH, while Cox regression was employed to determine independent factors of survival. RESULTS A total of 773 patients were included, and 20 red blood cells per high-power field was identified as the cutoff of SMH, of which 90 patients had preoperative SMH (11.6%) and 683 patients (88.4%) did not. Larger tumor size (OR = 1.10 [per cm], 95% CI 1.01-1.19, p = 0.036) and higher Fuhrman grade (grade 3 vs. grade 1-2, OR = 1.76, 95% CI 1.09-2.83, p = 0.02; grade 4 vs. grade 1-2, OR = 2.15, 95% CI 0.73-6.31, p = 0.164) were predictors of SMH. Compared to non-SMH patients, SMH patients had poorer DFS (HR = 3.16, 95% CI 2.07-4.83, p < 0.001) and OS (HR = 2.11, 95% CI 1.34-3.32, p = 0.001). CONCLUSION In summary, preoperative SMH is associated with larger tumor size and higher Fuhrman grade, and it is also independently correlated with poorer DFS and OS in non-metastatic RCC patients who underwent nephrectomy.
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Affiliation(s)
- Yaxiong Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanxiang Shao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shangqing Ren
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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