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

Figures

↓  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.
Figure 1.
↓  Figure 2. Overall survival after partial vs. radical nephrectomy for renal cancer.
Figure 2.
↓  Figure 3. Cancer-free survival after partial vs. radical nephrectomy for renal cancer.
Figure 3.
↓  Figure 4. Dialysis-free survival after partial vs. radical nephrectomy for renal cancer.
Figure 4.

Tables

↓  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 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 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 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)