World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 17, Number 2, April 2026, pages 237-246

Functional and Survival Outcomes of Partial Versus Radical Nephrectomy in Renal Cell Carcinoma Patients With Pre-Existing Chronic Kidney Disease: A Real-World Study

Figure 1. Patient selection and follow-up flow diagram for renal cancer study at Cho Ray Hospital (2019–2024). Note: Total patients (N = 90): RN group (n = 41); PN group (n = 49). Excluded from survival analysis (n = 17): loss to follow-up (n = 12); incomplete oncological records (n = 5). Final survival analysis cohort (N = 73): RN group (n = 33); PN group (n = 40). Final functional analysis cohort (N = 68): excluded (n = 5) due to missing 12-month creatinine data.

**Table 1.** Baseline Characteristics and Tumor Complexity by Surgical Group (N = 90)
Characteristic	RN group (N = 41)	PN group (N = 49)	Total cohort (N = 90)	P-value
This table summarizes patient demographics, clinical status, and tumor characteristics, demonstrating the selection bias in surgical indication. BMI: body mass index; eGFR: estimated glomerular filtration rate; ESRD: end-stage renal disease; Hb: hemoglobin; PN: partial nephrectomy; RCC: renal cell carcinoma; RN: radical nephrectomy.
Patient demographics and pre-operative health
Mean age (years)	59.5 ± 13.3	63.1 ± 10.9	61.5 ± 12.1	0.16
Male sex (%)	78	77.6	77.8	0.96
Mean BMI	21.2 ± 3.2	20.8 ± 2.8	21.0 ± 3.0	0.54
Flank pain (%)	-	-	53.3	-
Incidentally detected (%)	-	-	41.1	-
Cardiovascular disease (%)	-	-	45.1	-
Type II diabetes mellitus (%)	-	-	18.9	-
ESRD on dialysis (%)	9.8	0	4.4	0.042
Mean pre-operative Hb (g/L)	121.6 ± 25.2	137.6 ± 17.6	130.3 ± 22.8	< 0.001
Mean pre-operative eGFR (mL/min/1.73 m²)	43.2 ± 16.7	48.8 ± 10.4	46.3 ± 13.9	0.58
Baseline eGFR < 45 (mL/min/1.73 m²)	8 (19.5%)	10 (20.4%)	18 (20.0%)	0.92
Positive proteinuria (%)	41.5	38.8	40	0.482
Tumor and pathological characteristics
Median tumor size (cm)	8.0	3.7	5.9	< 0.001
Mean RENAL score	10.2	7.1	8.5	< 0.001
Post-operative ≥ T2 (%)	75.6	6.2	37.7	0.001
Histology: clear cell RCC (%)	75.5	69.4	72.3	0.4

Table 1. Baseline Characteristics and Tumor Complexity by Surgical Group (N = 90)

Characteristic

RN group (N = 41)

PN group (N = 49)

Total cohort (N = 90)

P-value

This table summarizes patient demographics, clinical status, and tumor characteristics, demonstrating the selection bias in surgical indication. BMI: body mass index; eGFR: estimated glomerular filtration rate; ESRD: end-stage renal disease; Hb: hemoglobin; PN: partial nephrectomy; RCC: renal cell carcinoma; RN: radical nephrectomy.

Patient demographics and pre-operative health

Mean age (years)

59.5 ± 13.3

63.1 ± 10.9

61.5 ± 12.1

0.16

Male sex (%)

77.6

77.8

0.96

Mean BMI

21.2 ± 3.2

20.8 ± 2.8

21.0 ± 3.0

0.54

Flank pain (%)

53.3

Incidentally detected (%)

41.1

Cardiovascular disease (%)

45.1

Type II diabetes mellitus (%)

18.9

ESRD on dialysis (%)

9.8

4.4

0.042

Mean pre-operative Hb (g/L)

121.6 ± 25.2

137.6 ± 17.6

130.3 ± 22.8

< 0.001

Mean pre-operative eGFR (mL/min/1.73 m²)

43.2 ± 16.7

48.8 ± 10.4

46.3 ± 13.9

0.58

Baseline eGFR < 45 (mL/min/1.73 m²)

8 (19.5%)

10 (20.4%)

18 (20.0%)

0.92

Positive proteinuria (%)

41.5

38.8

0.482

Tumor and pathological characteristics

Median tumor size (cm)

8.0

3.7

5.9

< 0.001

Mean RENAL score

10.2

7.1

8.5

< 0.001

Post-operative ≥ T2 (%)

75.6

6.2

37.7

0.001

Histology: clear cell RCC (%)

75.5

69.4

72.3

0.4

**Table 2.** Perioperative Outcomes and Early Functional Change (N = 90)
Outcome	RN group (N = 41)	PN group (N = 49)	Total cohort (N = 90)	P-value
This table summarizes surgical morbidity, technique utilized, and the initial functional response to surgery. AKI: acute kidney injury; eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.
Surgical technique and morbidity
Open surgery (%)	75.6	42.9	57.8	0.001
Minimally invasive/robot (%)	24.4	57.1	42.2	0.001
Mean blood loss (mL)	219.3 ± 307.7	118.2 ± 95.5	164.2 ± 223.6	0.02
Transfusion required (%)	12.2	0	5.6	0.017
Overall AKI incidence (%)	31.7	30.6	31.1	0.286
Emergency dialysis required (%)	7.3	0	3.3	0.091
Severe complication (≥ Clavien IIIa) (%)	9.76	2.04	5.5	0.229
Functional change
Change in eGFR post-operative (mL/min/1.73 m²)	-6.2 ± 9.0	−6.3 ± 7.5	−6.2 ± 8.2	0.652
Pre-operative eGFR vs. post-operative eGFR	P < 0.001 (Paired)	P < 0.001 (paired)	P < 0.001 (paired)	-

Table 2. Perioperative Outcomes and Early Functional Change (N = 90)

Outcome

RN group (N = 41)

PN group (N = 49)

Total cohort (N = 90)

P-value

This table summarizes surgical morbidity, technique utilized, and the initial functional response to surgery. AKI: acute kidney injury; eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.

Surgical technique and morbidity

Open surgery (%)

75.6

42.9

57.8

0.001

Minimally invasive/robot (%)

24.4

57.1

42.2

0.001

Mean blood loss (mL)

219.3 ± 307.7

118.2 ± 95.5

164.2 ± 223.6

0.02

Transfusion required (%)

12.2

5.6

0.017

Overall AKI incidence (%)

31.7

30.6

31.1

0.286

Emergency dialysis required (%)

7.3

3.3

0.091

Severe complication (≥ Clavien IIIa) (%)

9.76

2.04

5.5

0.229

Functional change

Change in eGFR post-operative (mL/min/1.73 m²)

-6.2 ± 9.0

−6.3 ± 7.5

−6.2 ± 8.2

0.652

Pre-operative eGFR vs. post-operative eGFR

P < 0.001 (Paired)

P < 0.001 (paired)

**Table 3.** Long-Term Renal Functional Outcomes (N = 68)
Outcome	RN group (N = 31)	PN group (N = 37)	P-value
This table demonstrates the long-term functional advantage of PN over RN, particularly regarding the magnitude of eGFR decline. eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.
Mean follow-up duration	45.7 ± 15.8 months
Pre-operative eGFR (baseline) (mL/min/1.73 m²)	49.8 ± 6.7	48.8 ± 11.1	0.522
Long-term eGFR (endpoint) (mL/min/1.73 m²)	26.5 ± 7.3	36.8 ± 10.8	-
Total eGFR decline (mL/min/1.73 m²)	−23.3 ± 6.0	−13.2 ± 3.5	< 0.001
CKD stage progression rate in F/U (%)	100% (31/31)	62.2% (23/37)	0.004
Subgroup: pre-operative eGFR ≥ 45 mL/min/1.73 m²	RN group (N = 23)	PN group (N = 27)	P-value
Pre-operative eGFR (baseline) (mL/min/1.73 m²)	53 ± 3.9	54.5 ± 4.1	0.124
Long-term eGFR (endpoint) (mL/min/1.73 m²)	28.3 ± 7.2	41.0 ± 6.9	-
eGFR decline (mL/min/1.73 m²)	−24.7 ± 5.3	−13.5 ± 3.8	< 0.001
Subgroup: pre-operative eGFR < 45 mL/min/1.73 m²	RN group (N = 8)	PN group (N = 10)	P-value
Pre-operative eGFR (baseline) (mL/min/1.73 m²)	40.5 ± 3.5	33.2 ± 8.7	0.083
Long-term eGFR (endpoint) (mL/min/1.73 m²)	21.3 ± 5.1	20.8 ± 8.3
eGFR decline (mL/min/1.73 m²)	−19.3 ± 6.5	−12.4 ± 2.5	0.002

Table 3. Long-Term Renal Functional Outcomes (N = 68)

Outcome

RN group (N = 31)

PN group (N = 37)

P-value

This table demonstrates the long-term functional advantage of PN over RN, particularly regarding the magnitude of eGFR decline. eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.

Mean follow-up duration

45.7 ± 15.8 months

Pre-operative eGFR (baseline) (mL/min/1.73 m²)

49.8 ± 6.7

48.8 ± 11.1

0.522

Long-term eGFR (endpoint) (mL/min/1.73 m²)

26.5 ± 7.3

36.8 ± 10.8

Total eGFR decline (mL/min/1.73 m²)

−23.3 ± 6.0

−13.2 ± 3.5

< 0.001

CKD stage progression rate in F/U (%)

100% (31/31)

62.2% (23/37)

0.004

Subgroup: pre-operative eGFR ≥ 45 mL/min/1.73 m²

RN group (N = 23)

PN group (N = 27)

P-value

Pre-operative eGFR (baseline) (mL/min/1.73 m²)

53 ± 3.9

54.5 ± 4.1

0.124

Long-term eGFR (endpoint) (mL/min/1.73 m²)

28.3 ± 7.2

41.0 ± 6.9

eGFR decline (mL/min/1.73 m²)

−24.7 ± 5.3

−13.5 ± 3.8

< 0.001

Subgroup: pre-operative eGFR < 45 mL/min/1.73 m²

RN group (N = 8)

PN group (N = 10)

P-value

Pre-operative eGFR (baseline) (mL/min/1.73 m²)

40.5 ± 3.5

33.2 ± 8.7

0.083

Long-term eGFR (endpoint) (mL/min/1.73 m²)

21.3 ± 5.1

20.8 ± 8.3

eGFR decline (mL/min/1.73 m²)

−19.3 ± 6.5

−12.4 ± 2.5

0.002

**Table 4.** Long-Term Survival Outcomes and Predictors of Mortality (N = 73)
Outcome	PN group (N = 40)	RN group (N = 33)	P-value
This table confirms comparable survival rates between the two surgical groups, while identifying independent systemic risk factors for overall mortality. eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.
Overall survival (OS) rate (%)	75.0	69.7	0.74
Cancer-free survival (CFS) rate (%)	82.5	75.8	0.35
Dialysis-free survival (DFS) rate (%)	85.0	78.8	0.59
Independent risk factors for overall mortality (Cox regression)	Hazard ratio (HR)	95% Confidence interval (CI)	P-value
Age (per year increase)	1.1	1.02–1.12	0.01
Positive proteinuria	5.4	1.35–21.81	0.017
Preoperative eGFR	0.97	0.93–1.0	0.064
Tumor size	1.07	0.87–1.32	0.503
RENAL score	1.02	0.78–1.33	0.89

Table 4. Long-Term Survival Outcomes and Predictors of Mortality (N = 73)

Outcome

PN group (N = 40)

RN group (N = 33)

P-value

This table confirms comparable survival rates between the two surgical groups, while identifying independent systemic risk factors for overall mortality. eGFR: estimated glomerular filtration rate; PN: partial nephrectomy; RN: radical nephrectomy.

Overall survival (OS) rate (%)

75.0

69.7

0.74

Cancer-free survival (CFS) rate (%)

82.5

75.8

0.35

Dialysis-free survival (DFS) rate (%)

85.0

78.8

0.59

Independent risk factors for overall mortality (Cox regression)

Hazard ratio (HR)

95% Confidence interval (CI)

P-value

Age (per year increase)

1.1

1.02–1.12

0.01

Positive proteinuria

5.4

1.35–21.81

0.017

Preoperative eGFR

0.97

0.93–1.0

0.064

Tumor size

1.07

0.87–1.32

0.503

RENAL score

1.02

0.78–1.33

0.89

**Table 5.** Correlation of Factors With Magnitude of Long-Term eGFR Decline (N = 68)
Factor	Correlation coefficient (Pearson/Tau)	P-value	Interpretation (direction of decline)
eGFR: estimated glomerular filtration rate.
Total RENAL score	−0.454 (inverse)	< 0.001	Correlates with greater decline
Tumor size	−0.500 (inverse)	< 0.001	Correlates with greater decline
Intraoperative blood loss	−0.353 (inverse)	0.012	Correlates with greater decline
Pre-operative eGFR	0.546 (positive)	< 0.001	Correlates with less decline (protective)
eGFR of contralateral kidney	0.349 (positive)	0.014	Correlates with less decline (protective)

Table 5. Correlation of Factors With Magnitude of Long-Term eGFR Decline (N = 68)

Factor

Correlation coefficient (Pearson/Tau)

P-value

Interpretation (direction of decline)

eGFR: estimated glomerular filtration rate.

Total RENAL score

−0.454 (inverse)

< 0.001

Correlates with greater decline

Tumor size

−0.500 (inverse)

< 0.001

Correlates with greater decline

Intraoperative blood loss

−0.353 (inverse)

0.012

Correlates with greater decline

Pre-operative eGFR

0.546 (positive)

< 0.001

Correlates with less decline (protective)

eGFR of contralateral kidney

0.349 (positive)

0.014

Correlates with less decline (protective)