肾部分切除术与根治性肾切除术治疗T<sub>2</sub>期肾细胞癌的预后比较：一项单中心回顾性研究

doi:10.3877/cma.j.issn.1674-3253.2026.05.005

目的

随着影像学评估精细化及机器人微创技术的发展，肾部分切除术（PN）越来越广泛应用于T₂期肾细胞癌患者，本研究通过比较T₂期肾细胞癌患者PN与根治性肾切除术（RN）的中长期预后，评估PN在T₂期肾细胞癌中的安全性和可行性。

方法

回顾性分析本中心2017年1月至2025年12月期间接受手术治疗的246例T₂期肾细胞癌患者临床资料，其中PN组61例，RN组185例。以无病生存（DFS）、总生存（OS）及肿瘤特异性生存（CSS）为主要观察终点。为减少组间基线特征分布差异造成的偏倚，本研究采用了基于倾向性评分的治疗组平均处理效应（ATT）加权方法。

结果

PN组61例患者中出现复发/转移的患者有2例，无死亡病例；RN组185例患者中出现复发/转移有20例，死亡患者有14例，其中12例死于肾细胞癌。ATT加权后，两组在DFS（P=0.116）、OS（P=0.147）及CSS（P=0.088）方面差异均无统计学意义。PN组患者的术后估算肾小球滤过率（eGFR）下降百分比均显著低于RN组（P<0.001）。

结论

在严格病例筛选及规范手术操作的前提下，肾部分切除术在T₂期肾细胞癌患者中可获得与根治性肾切除术相当的肿瘤学结局，因此可作为部分患者的合理手术选择。

关键词: 肾细胞癌, T₂期, 肾部分切除术, 根治性肾切除术, 预后

Objective

With advances in refined imaging assessment and robot-assisted minimally invasive techniques, partial nephrectomy (PN) has been increasingly applied in patients with T₂ renal cell carcinoma (RCC). This study aimed to compare the mid- to long-term outcomes of PN and radical nephrectomy (RN) in patients with T₂ RCC, and to evaluate the safety and feasibility of PN in this setting.

Methods

The clinical data of 246 patients with T₂ RCC who underwent surgical treatment at our center between January 2017 and December 2025 were retrospectively analyzed, including 61 patients in the PN group and 185 in the RN group. The primary endpoints were disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). To reduce bias caused by baseline differences between groups, an average treatment effect on the treated (ATT) weighting method based on propensity scores was applied.

Results

Among the 61 patients in the PN group, 2 experienced recurrence or metastasis, and no deaths were observed. In the RN group, 20 of 185 patients developed recurrence or metastasis, and 14 patients died, of whom 12 died from RCC. After ATT weighting, no statistically significant differences were observed between the two groups in DFS (P=0.116), OS (P=0.147), or CSS (P=0.088). The percentage decline in postoperative estimated glomerular filtration rate (eGFR) was significantly lower in the PN group than in the RN group (P<0.001).

Conclusion

Under careful patient selection and appropriate surgical practice, partial nephrectomy can achieve oncologic outcomes comparable to radical nephrectomy in patients with T₂ RCC, and may therefore be considered a reasonable surgical option in selected patients.

Key words: Renal cell carcinoma, T₂ stage, Partial nephrectomy, Radical nephrectomy, Prognosis

表1 246例T₂期肾细胞癌患者临床资料

	加权前				加权后
	RN (n=185)	PN (n=61)	SMD	P值	RN	PN	SMD	P值
年龄[岁，(±s)]	52.81±13.14	51.79±14.48	0.074	0.625	53.82±12.84	51.79±14.48	0.151	0.244
BMI [kg/m²，(±s)]	23.36±3.30	24.11±2.55	0.255	0.067	23.69±3.31	24.11±2.55	0.144	0.257
肿瘤最大径[cm，(±s)]	9.43±2.54	8.09±1.38	0.653	<0.001	8.15±1.20	8.09±1.38	0.049	0.704
术前eGFR[mL/min (1.73 m²)，(±s)]	87.49±17.71	93.67±20.38	0.324	0.037	90.82±15.66	93.67±20.38	0.158	0.220
术后eGFR[mL/min (1.73 m²)，(±s)]	62.68±17.05	76.89±23.65	0.689	<0.001	61.59±17.47	76.89±23.65	0.740	<0.001
eGFR下降百分比[%，(±s)]	28.40±12.28	18.69±13.42	0.755	<0.001	32.56±12.38	18.69±13.42	1.082	<0.001
性别[例（%）]			0.279	0.090			0.128	0.642
男	109 (58.92)	44 (72.13)			77.66	72.13
女	76 (41.08)	17 (27.87)			22.34	27.87
肿瘤分期(T分期)[例（%）]			0.631	0.001			0.034	0.839
T_2a	135 (72.97)	58 (95.08)			94.32	95.08
T_2b	50 (27.03)	3 (4.92)			5.68	4.92
病理类型[例（%）]			0.306	0.190			0.102	0.887
透明细胞癌	120 (64.87)	34 (55.74)			59.07	55.74
乳头状癌	12 (6.49)	8 (13.12)			10.20	13.12
嫌色细胞癌	31 (16.76)	8 (13.12)			9.87	13.12
其他	22 (11.89)	11 (18.03)			20.86	18.03
核分级[例（%）]			0.285	0.470			0.209	0.589
Ⅰ级	10 (5.41)	4 (6.56)			2.28	6.56
Ⅱ级	130 (70.27)	45 (73.77)			70.37	73.77
Ⅲ级	38 (20.54)	12 (19.67)			27.36	19.67
Ⅳ级	7 (3.78)	0 (0)			0	0
手术方式[例（%）]			1.634	< 0.001			0.083	0.905
腹腔镜	71 (38.38)	11 (18.03)			21.13	18.03
机器人	33 (17.84)	48 (78.69)			75.20	78.69
开放	81 (43.78)	2 (3.28)			3.68	3.28

表1 246例T₂期肾细胞癌患者临床资料

	加权前				加权后
	RN (n=185)	PN (n=61)	SMD	P值	RN	PN	SMD	P值
年龄[岁，(±s)]	52.81±13.14	51.79±14.48	0.074	0.625	53.82±12.84	51.79±14.48	0.151	0.244
BMI [kg/m²，(±s)]	23.36±3.30	24.11±2.55	0.255	0.067	23.69±3.31	24.11±2.55	0.144	0.257
肿瘤最大径[cm，(±s)]	9.43±2.54	8.09±1.38	0.653	<0.001	8.15±1.20	8.09±1.38	0.049	0.704
术前eGFR[mL/min (1.73 m²)，(±s)]	87.49±17.71	93.67±20.38	0.324	0.037	90.82±15.66	93.67±20.38	0.158	0.220
术后eGFR[mL/min (1.73 m²)，(±s)]	62.68±17.05	76.89±23.65	0.689	<0.001	61.59±17.47	76.89±23.65	0.740	<0.001
eGFR下降百分比[%，(±s)]	28.40±12.28	18.69±13.42	0.755	<0.001	32.56±12.38	18.69±13.42	1.082	<0.001
性别[例（%）]			0.279	0.090			0.128	0.642
男	109 (58.92)	44 (72.13)			77.66	72.13
女	76 (41.08)	17 (27.87)			22.34	27.87
肿瘤分期(T分期)[例（%）]			0.631	0.001			0.034	0.839
T_2a	135 (72.97)	58 (95.08)			94.32	95.08
T_2b	50 (27.03)	3 (4.92)			5.68	4.92
病理类型[例（%）]			0.306	0.190			0.102	0.887
透明细胞癌	120 (64.87)	34 (55.74)			59.07	55.74
乳头状癌	12 (6.49)	8 (13.12)			10.20	13.12
嫌色细胞癌	31 (16.76)	8 (13.12)			9.87	13.12
其他	22 (11.89)	11 (18.03)			20.86	18.03
核分级[例（%）]			0.285	0.470			0.209	0.589
Ⅰ级	10 (5.41)	4 (6.56)			2.28	6.56
Ⅱ级	130 (70.27)	45 (73.77)			70.37	73.77
Ⅲ级	38 (20.54)	12 (19.67)			27.36	19.67
Ⅳ级	7 (3.78)	0 (0)			0	0
手术方式[例（%）]			1.634	< 0.001			0.083	0.905
腹腔镜	71 (38.38)	11 (18.03)			21.13	18.03
机器人	33 (17.84)	48 (78.69)			75.20	78.69
开放	81 (43.78)	2 (3.28)			3.68	3.28

图1 加权后T₂期肾细胞癌患者的Kaplan-Meier生存曲线

图2 加权后T_2a期肾细胞癌患者的Kaplan–Meier生存曲线

图3 T₂期和T_2a期肾细胞癌患者组术后eGFR下降情况

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Comparative prognosis of partial nephrectomy and radical nephrectomy in patients with T₂ renal cell carcinoma: a single-center retrospective study

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Comparative prognosis of partial nephrectomy and radical nephrectomy in patients with T2 renal cell carcinoma: a single-center retrospective study

Comparative prognosis of partial nephrectomy and radical nephrectomy in patients with T₂ renal cell carcinoma: a single-center retrospective study