ScholarWorks@성균관대학교

초록

Upstaging to pT3a has been associated with adverse oncologic outcomes; however, previous studies included mixed partial and radical nephrectomy cohorts, potentially introducing selection bias. Data focusing on robot-assisted partial nephrectomy (RAPN) remain limited. This study aimed to evaluate the incidence, preoperative predictors, and prognostic impact of pT3a upstaging in a large RAPN cohort. We retrospectively analyzed patients with clinical T1–T2 renal cell carcinoma who underwent RAPN between January 2010 and May 2025. Demographic, radiologic, and laboratory variables, including inflammatory and nutritional indices, were collected and analyzed. Logistic regression was used to identify predictors of pT3a upstaging. Local recurrence–free survival (LRFS) and metastasis-free survival (MFS) were assessed using Kaplan–Meier and Cox regression analyses. Receiver operating characteristic (ROC) analysis was performed to determine the optimal RENAL score cutoff. Among 2,016 patients, pT3a upstaging occurred in 38 (1.9%) during a median follow-up of 37 months. Older age (OR, 1.04; 95% CI, 1.01–1.08; p = 0.007) and higher RENAL score (OR, 1.35; 95% CI, 1.16–1.59; p < 0.001) were independent predictors. A RENAL score cutoff of ≥ 7 was identified (area under the ROC curve, 0.65; 95% CI, 0.56–0.74), with a high negative predictive value for occult pT3a disease (99.3%). Overall, pT3a upstaging was not independently associated with LRFS or MFS. In subgroup analysis according to invasion pattern, venous invasion was associated with an increased risk of metastasis (HR, 6.14; 95% CI, 1.12–33.75; p = 0.037), whereas fat-only invasion was not. Pathological upstaging to pT3a after RAPN is rare and primarily associated with tumor complexity and patient age. Although overall upstaging does not adversely affect oncologic outcomes, venous invasion represents a high-risk subgroup for metastatic progression.

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