Abstract
BACKGROUND: Distant metastases can still occur in T1a renal cancer. There is no conclusive evidence to determine whether cytoreductive partial nephrectomy (cPN) or cytoreductive radical nephrectomy (cRN) is superior in managing primary renal lesions. This study aimed to compare survival outcomes between cPN and cRN in pathological T1a renal cell carcinoma (RCC) patients with distant metastases and to develop a predictive model for metastasis risk stratification. METHODS: T1a RCC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic comparisons were made using Kaplan-Meier analysis. Univariate and multivariate logistic regression analyses were conducted to assess the risk factors for distant metastases in T1a RCC, leading to the development of a predictive model. The model's performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The study included 55,957 RCC patients with pathologic T1a, of which 1,496 (2.67%) with distant metastases. Metastatic patients exhibited significantly worse overall survival (OS) than non-metastatic counterparts (P<0.001). There was no notable difference in OS between cPN and cRN (P=0.11). Univariate and multivariate analyses identified advanced age, male gender, poor histological differentiation, sarcomatoid features, capsular invasion, and lymph node metastasis as independent risk factors for distant metastases in RCC patients with stage T1a. The predictive model established on these factors demonstrated performance with an area under the curve of 0.789. CONCLUSIONS: There was no significant difference in OS between cPN and cRN. Advanced age, male gender, poor histological differentiation, capsular invasion, sarcomatoid features, and lymph node metastasis were independent risk factors for distant metastases in RCC patients with stage T1a.