Partial Versus Radical Nephrectomy In Different Nuclear Grades Of PT1 Clear Cell Renal Cell Carcinoma

Background: The accuracy of imaging methods to predict the nuclear grade of clear cell renal cell carcinoma(cc RCC)before surgery has improved.Thus,it is important to reconsider the oncologic outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)in terms of the different nuclear grades.This study aimed to evaluate the associations of PN and RN in the overall cohort and 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,p T1,N0,and M0 cc RCC 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 five different methods of propensity score(PS)analysis.Results: A total of 1,675 patients formed the cohort for PS analysis,which included 774 patients who underwent RN and 901 patients who underwent PN.After overlap weighting(OW),RN associated with a reduced risk of local ipsilateral recurrence in the overall cohort(hazard ratio [HR] = 0.147,95% CI 0.064–0.338;p < 0.001),G2 subset(HR =0.148,95% CI 0.046–0.474;p = 0.001),G3 subset(HR = 0.097,95% CI0.021–0.455;p = 0.003),and G4 subset(HR = 0.091,95% CI0.011–0.736;p = 0.025)compared with PN.An association between RN and a reduced risk of distant metastases in the overall cohort(HR = 0.419,95% CI 0.232–0.757;p = 0.004)and G4 subset(HR = 0.071,95% CI0.016–0.325;p = 0.001)was also observed.No significant difference in ACM between PN and RN was identified.Conclusions: Compared with PN,RN was associated with a reduced risk of local ipsilateral recurrence in the overall cohort,as well as G2,G3,and G4 subsets,and a reduced risk of distant metastases in the overall cohort and G4 subset.However,it was not associated with a difference in ACM among patients with p T1-stage cc RCC.These results are supportive of treating patients with high nuclear grade(especially G4)cc RCC with RN rather than PN.