为了确定临床风险因素和术前成像的形态学特征是否可以用于确定cT1肿瘤（患有pT3a）升级风险较高的患者，我们进行了一项回顾性的国际病例对照研究。该研究包括2010年1月至2018年12月期间行手术治疗的非转移性RCC（cT1 N0）患者，接受根治性肾切除或部分肾切除。我们使用多变量 logistic 回归模型研究了所有患者以及亚组（术前肿瘤小于4厘米、肾造血功能得分、术前肿瘤小于4厘米并且肾造血功能得分和透明细胞组织学）中术前危险因素与pT3a 病理升级之间的关联。我们还研究了与pT3a子组（肾静脉、窦脂肪、肾周脂肪）的关联。结果和限制：在4092名部分肾切除患者和2056名根治性肾切除患者中，病理学升级发生在4.9%和23.3%的患者中。在每个组中，与pT3a升级相关的独立因素包括术前肿瘤大小增加、年龄增加和糖尿病存在。具体来说，在部分肾切除患者中，糖尿病（概率比 OR = 1.65；95%置信区间 CI 1.17,2.29）、男性（OR = 1.62；95% CI 1.14,2.33）以及增加的 BMI（OR = 1.03；95% CI 1.00,1.05）与升级有统计学相关性。亚组分析发现，叶门肿瘤更容易升级（部分肾切除 OR = 1.91；95% CI 1.12,3.16 | 根治性肾切除 OR = 2.16；95% CI 1.44,3.25）。糖尿病和较高的 BMI 与病理学升级有关，术前肿瘤大小增加、年龄增加和男性也与之相关。类似地，叶门肿瘤经常被升级。

To determine whether clinical risk factors and morphometric features on pre-operative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a).A retrospective international case control study of consecutive patients treated surgically with radical or partial nephrectomy for non-metastatic RCC (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of pre-operative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with pre-operative tumors <4cm, renal nephrometry scores, tumors <4cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat).Resultsand Limitations: Among the 4092 PN and 2056 RN patients, pathologic upstaging occurred in 4.9% and 23.3% patients, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among PN subjects diabetes (odds ratio, OR =1.65; 95% CI 1.17,2.29), male sex (OR = 1.62; 95% CI 1.14,2.33), and increasing BMI (OR =1.03; 95%CI 1.00,1.05 per one unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (PN OR = 1.91; 95%CI 1.12,3.16 | RN OR = 2.16; 95% 1.44, 3.25).Diabetes and higher BMI were associated with pathologic upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.