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Minimally Invasive Partial versus Radical Nephrectomy for Non-metastatic pT3a Renal Cell Carcinoma: a Multicenter Matched Cohort Study

Year: 2026
Type: article
Study design: Observational Study
Abstract: PURPOSE: To evaluate oncological and functional outcomes of minimally invasive partial and radical nephrectomy (MIS-PN vs. MIS-RN) in patients with pT3aN0M0 renal cell carcinoma (RCC). MATERIALS AND METHODS: We performed a multicenter retrospective study of patients with pT3aN0M0 RCC treated with MIS-PN or MIS-RN. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included de novo eGFR <60 mL/min/ 1.73 m2 (CKD-S) and <45 mL/min/ 1.73 m2 (CKD-S3b) at the new baseline (1-12 month postoperatively), as well as CKD-S at the latest follow-up (>1 year postoperatively). A 1:2 ratio propensity score matching (PSM) was applied to balance covariates, and inverse probability weighting (IPW) served as sensitivity analysis. Survival curves were estimated using the Kaplan-Meier method, and multivariable analyses (MVA) were performed to identify predictors of oncological and functional outcomes. RESULTS: A total of 303 patients were enrolled (113 MIS-PN/190 MIS-RN) with a median follow-up of 39.0 months (IQR 26.8-52.9). After PSM (66 MIS-PN/54 MIS-RN), no significant difference in RFS was observed between two groups (p=0.23). MVA revealed that surgical approach was not an independent predictor of RFS (HR: 1.00, p=1.00). Among patients with available new baseline eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN was independently associated with a higher risk of CKD-S (OR: 7.96, p=0.03). Among patients with available the latest follow-up eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN remained an independent predictor of CKD-S at the latest follow-up (OR: 7.98, p=0.03). IPW analysis yielded consistent results. Additionally, IPW identified MIS-RN as an independent risk factor for CKD-S3b at the new baseline (OR: 18.29, p<0.01). CONCLUSION: MIS-PN provided comparable mild term oncologic outcomes to MIS-RN while offering superior renal function preservation. MIS-PN may be a viable option for selected T3a RCC patients when nephron preservation is indicated.
DOI: 10.1590/s1677-5538.ibju.2025.0500
Authors: Xiangpeng Zou, Zhenhua Liu, Yunhan Luo, Peimin Zhou, Longbin Xiong, Zhoujie Sun, Xuesong Li, Peng Hong, Kangbo Huang, Chunsen Yang, Zhaohui Zhou, Yulu Peng, Xin Luo, Junhang Luo, Xin Yao, Shengjie Guo, Pei Dong, Hui Han, Fangjian Zhou, Shudong Zhang, Wei Yu, Zhiling Zhang
Institutions: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Peking University, Peking University First Hospital, Peking University Third Hospital, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Sun Yat-sen University
Language: English
Field: Medicine
Open Access status: diamond
Awards: G1481074523, G1941023296, G2034082051, G2107190728, G2417528971, G3164315962, G3285215500, G3366223558, G3558002482, G4476164955, G4479912065, G4494960682, G4557925950, G4631778564, G4721915229, G5095465560, G5824213096, G5834504324, G6073486075, G6190995213, G6314155077, G6318367429, G6335478363, G6554973431, G6754165184, G7386740838, G7404954259, G7624583792, G7874641799, G8075640907, G8280577932, G8600851580, G8860575613, G891357020, G8964828975
OpenAlex ID: W7128052519
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