关键词: 癌, 肾细胞；肾透明细胞癌；肾部分切除术；根治性肾切除术；SEER数据库；预后

Abstract: Background　At present，partial nephrectomy（PN）is preferred for patients with localized T1a clear cell renal cell carcinoma（ccRCC）.However，it remains controversial whether PN is the first-choice surgical procedure for patients with localized T1b ccRCC.Objective　To estimate the effects of PN on overall survival（OS）and cancer-specific survival（CSS）of patients with localized Ⅰ ccRCC.Methods　From April to May 2020，we downloaded the clinicopathological data of patients diagnosed with ccRCC pathologically from 1975 to 2016（year of diagnosis，age，sex，race，marital status，tumor laterality，pathological stage，T stage，surgical method）from SEER after getting permission to use the database.According to the use of surgical techniques，the patients were divided into PN group and radical nephrectomy（RN）group.Cox proportional hazards regression model was used to identify independent prognostic factors of CSS in patients with localized I ccRCC.Multivariate Logistic regression analysis was used to explore the the influencing factors of surgical methods in patients with ccRCC.Propensity score matching method was used to adjust samples.Kaplan-Meier curve and multivariate Cox proportional hazards regression model were used to estimate the effects of two surgical methods on the OS and CSS of patients before and after matching.Results　The results of univariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were factors associated with CSS in patients with localized ⅠccRCC（P<0.05）.The results of multivariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were all independent factors for CSS in patients with localizedⅠ ccRCC（P<0.05）.In terms of evaluating the prognostic value of surgical method by overall survival population and tumor specific survival population，localized T1b stage ccRCC with PN and those with RN had statistically significant differences in the year of diagnosis，age，tumor laterality and pathological stage（P<0.05）.Multivariate Logistic regression analysis revealed that year of diagnosis，age，tumor laterality and pathological stage were associated with the use of surgery method in patients with localized T1b stage ccRCC（P<0.05）.Kaplan-Meier survival analysis found that either before or after propensity score matching，PN significantly prolonged the OS（P<0.05），but showed similar effect on the CSS（P>0.05）of patients compared with RN.After propensity score matching，multivariate Cox regression analysis found that PN was independently associated with prolonged OS of patients（HR=0.695，P=0.009），but was not significantly associated with CSS（HR=0.804，P=0.301）.Conclusion　When surgery is feasible，PN is recommended as the first-choice surgical mode for patients with stage ⅠccRCC in light of long-term survival.

Key words: Carcinoma, renal cell；Clear cell renal cell carcinoma；Partial nephrectomy；Radical nephrectomy；SEER database；Prognosis