肾功能恶化与全因死亡率增加相关。对于大于 4 cm 的肾脏肿块，部分肾切除术与根治性肾切除术（PN 与 RN）是否会影响长期功能结果尚不清楚。本研究测试了 PN 与 RN 之间的关系，与术后急性肾损伤 (AKI)、1 年时恢复至少 90% 的术前估计肾小球滤过率 (eGFR)、慢性肾病 (CKD) 升级一期或以上之间的关系1 年时 eGFR 下降 45 ml/min/1.73 m2 或更少。使用了来自 23 个高容量机构的数据。该研究仅包括经手术治疗且患有单一、单侧、局部、临床 T1b-2 肾脏肿块的患者。进行多变量逻辑回归分析。总共确定了 968 名 PN 患者和 325 名 RN 患者。 PN 患者的 AKI 发生率低于 RN 患者（17% vs. 58%；p < 0.001）。术后 1 年，PN 患者与 RN 患者相比，基线 eGFR 恢复至少 90% 的比率分别为 51% 和 16%，CKD 进展≥ 1 期的比率分别为 38% 和 65%，并且eGFR 下降率为 45 ml/min/1.73 m2 或更低时，分别为 10% 和 23%（均 p < 0.001）。根治性肾切除术独立预测 AKI（比值比 [OR]，7.61）、1 年 ≥ 90% eGFR 恢复（OR，0.30）、1 年 CKD 升期（OR，1.78）和 1 年 eGFR 下降 45 ml/ min/1.73 m2 或更少（OR，2.36）（所有 p ≤ 0.002）。对于 cT1b-2 肿块，RN 预示着更差的近期和 1 年功能结果。在技​​术可行且肿瘤学安全的情况下，应努力在肾脏肿块较大的情况下保留肾脏，以避免肾小球功能丧失相关死亡的危险。© 2024。外科肿瘤学会。

Deterioration of renal function is associated with increased all-cause mortality. In renal masses larger than 4 cm, whether partial versus radical nephrectomy (PN vs. RN) might affect long-term functional outcomes is unknown. This study tested the association between PN versus RN and postoperative acute kidney injury (AKI), recovery of at least 90% of the preoperative estimated glomerular filtration rate (eGFR) at 1 year, upstaging of chronic kidney disease (CKD) one stage or more at 1 year, and eGFR decline of 45 ml/min/1.73 m2 or less at 1 year.Data from 23 high-volume institutions were used. The study included only surgically treated patients with single, unilateral, localized, clinical T1b-2 renal masses. Multivariable logistic regression analyses were performed.Overall, 968 PN patients and 325 RN patients were identified. The rate of AKI was lower in the PN versus the RN patients (17% vs. 58%; p < 0.001). At 1 year after surgery, for the PN versus the RN patients, the rate for recovery of at least 90% of baseline eGFR was 51% versus 16%, the rate of CKD progression of ≥ 1 stage was 38% versus 65%, and the rate of eGFR decline of 45 ml/min/1.73 m2 or less was 10% versus 23% (all p < 0.001). Radical nephrectomy independently predicted AKI (odds ratio [OR], 7.61), 1-year ≥ 90% eGFR recovery (OR, 0.30), 1-year CKD upstaging (OR, 1.78), and 1-year eGFR decline of 45 ml/min/1.73 m2 or less (OR, 2.36) (all p ≤ 0.002).For cT1b-2 masses, RN portends worse immediate and 1-year functional outcomes. When technically feasible and oncologically safe, efforts should be made to spare the kidney in case of large renal masses to avoid the hazard of glomerular function loss-related mortality.© 2024. Society of Surgical Oncology.