Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis

Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis Zhiying Wu, Zixuan Xue, Binshuai Wang, Dameng Pan, Min Qiu, Hongxian Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6970338/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Objectives Mortality rates for renal cell carcinoma (RCC) are significantly higher among elderly patients than among younger populations. Comorbidities have a substantial influence on the overall prognosis of elderly individuals undergoing RCC treatment. The aim of this study is to identify prognostic factors specific to older adults with RCC. Methods This retrospective study enrolled consecutive patients aged 75 years or over with histologically confirmed RCC who were treated at Peking University Third Hospital between January 2012 and December 2024. All participants underwent partial or radical nephrectomy, performed by urological oncology specialists. Adjuvant therapy was administered according to contemporary clinical guidelines. Comprehensive clinicopathological data were systematically collected, including tumor stage (AJCC 8th edition) and histological subtype. Comorbidity burden was objectively assessed using the Charlson Comorbidity Index (CCI), with scores calculated according to standard weighting algorithms. The primary endpoint of the study was all-cause mortality, with follow-up conducted until the end of December 2024. Results This study analyzed 176 consecutive RCC patients aged 75 years or over (median age 78 years, range 75–87 years), comprising 115 males (65.3%) and 61 females (34.7%). Comorbidities were prevalent, with 61.6% of patients having hypertension and a median CCI score of 1 (range 0–7). During a median follow-up period of 44 months, there were 37 deaths (21.0% mortality), including 25 cancer-specific deaths (14.2%) and 12 non-oncological deaths (6.8%). Notably, the 80–87 age subgroup demonstrated significantly lower RCC-associated mortality (p = 0.029). Survival rates were 97.3% in one year, 90.4% in three years and 75.2% in five years. CCI ≥ 3, symptoms, tumor diameter > 4 cm, distant metastasis, Clavien ≥ 3 and AJCC stage independently predicted poorer overall survival in geriatric RCC patients. A nomogram with a C-index of 0.774 (95% CI: 0.712–0.835) was subsequently developed, demonstrating good discriminative ability. Conclusions Elderly patients with RCC can still benefit from surgery, and the prognosis is influenced by tumor biology and comorbidities. Partial nephrectomy may be considered on a case-by-case basis for patients over 80 years of age who have limited renal cancer combined with multiple comorbidities. Renal cell carcinoma elderly patients survival analysis risk factors CCI Figures Figure 1 Figure 2 Figure 3 Background RCC, a prevalent malignancy arising from the renal tubular epithelium, accounts for around 3% of all cancers in adults worldwide [ 1 ] . The disease burden in China remains substantial, with epidemiological data from 2022 reporting an estimated 73,700 new cases and 24,000 deaths annually [ 2 ] . Established risk factors include advanced age, tobacco use, obesity, and hypertension, as demonstrated by multiple population-based studies [ 3 ] . The intersection of demographic ageing and the increasing prevalence of metabolic disorders has led to a rising incidence of RCC among elderly populations. Of particular concern is the growing proportion of patients diagnosed at 75 years or older, who often present with more complex comorbidities and higher surgical risks. However, despite this epidemiological shift, there is limited robust evidence regarding survival outcomes and prognostic factors in elderly RCC patients, particularly in the Chinese population [ 4 , 5 ] . This single-center retrospective study (2012–2024) aimed to address the knowledge gap in geriatric RCC research in China by specifically evaluating postoperative survival and perioperative complications in elderly RCC patients (≥ 75 years). Through a systematic evaluation of clinicopathological characteristics and comorbidity profiles, we intend to pinpoint modifiable risk factors that influence OS and PFS in this vulnerable patient group. We expect our findings to inform clinical decision-making and improve risk stratification for elderly RCC patients undergoing surgery. Materials and methods Study cohort This retrospective analysis included 4,062 consecutive patients with histologically confirmed RCC who underwent surgical intervention at Peking University Third Hospital between January 2012 and April 2024. From this cohort, we identified 176 patients aged 75 years or over at diagnosis (Fig. 1 ), comprising 119 patients (67.6%) aged 75–79 years and 57 patients (32.4%) aged 80 years or over. (Table 1 ). Table 1 Comparative analysis of clinicopathological features in elderly RCC patients: <80 years vs. ≥80 years Variables ALL 75–79 years 80-89years P value 176 119 57 Gender 0.006 Male 115 70 45 Female 61 49 12 BMI 0.242 24.9 71 43 28 Chief symptoms 0.317 Symptomatic 34 24 10 Lumbago 13 9 4 Hematuria 20 14 6 Others 1 1 0 Examinations reveal 142 95 47 Mean duration of symptoms (day) 30(2-5475) 30(2-5475) 30(3-3650) 0.932 Previous history Hypertension 109 70 39 0.144 Diabetes 45 32 13 0.349 Heart disease 42 28 14 0.511 Cerebrovascular disease 29 19 10 0.474 Kidney disease 6 5 1 Operations 95 61 34 Infectious diseases 9 5 4 Others malignancy 9 5 4 Others 38 27 11 CCI ≥ 3 0.504 ASA classification 0.124 1 7 7 0 2 124 84 40 3 44 28 16 4 1 0 1 Side 0.456 Left 101 66 35 Right 75 53 22 Surgery 0.106 PN 84 61 23 RN 92 58 34 Operation method 0.609 Laparoscopy 140 97 43 Robot-assisted laparoscopy 34 21 13 Open surgery 2 1 1 Operative time(min) 150.43 ± 58.00 150.49 ± 61.29 150.30 ± 50.93 0.984 Postoperative hospital stay (day) 6.78 ± 5.06 7.01 ± 5.57 6.31 ± 3.73 0.385 Tumor diameter (cm) 4.28 ± 2.14 4.25 ± 2.18 4.33 ± 2.08 0.282 Tumor diameter > 4 cm 89 58 31 0.545 Morphology 0.965 CCRCC 158 107 51 PRCC 8 5 3 CRCC 6 4 2 others 4 3 1 Nuclear grade 0.749 G1 13 11 2 G2 105 71 34 G3 32 20 12 G4 12 8 4 pT classification 0.585 pT1 119 78 41 pT2 6 5 1 pT3 49 34 15 pT4 2 2 0 pN classification 0.488 pNX/pN0 175 118 57 pN1 1 1 0 pM classification 0.580 pMx/pM0 169 113 56 pM1 7 6 1 Pathological stage 0.552 I 118 78 40 II 4 3 1 III 45 30 15 IV 9 8 1 Patient status at the last follow-up 0.470 Lost to follow-up 16 10 6 Alive 123 82 41 Death 37 27 10 0.029 * RCC-deaths 25 21 4 Non-RCC deaths 12 6 6 Five-year survival rate 75.2% 73.0% 84.2% BMI body mass index, ASA American society of anesthesiologists, PN partial nephrectomy, RN radical nephrectomy, CCRCC clear cell renal cell carcinoma, PRCC papillary renal cell carcinoma, CRCC chromophobe renal cell carcinoma All participants voluntarily elected to undergo surgery after providing written informed consent. The study protocol was approved by the Institutional Review Board of Peking University Third Hospital (Approval No. 582-01). Surgical method All patients underwent either partial (PN: n = 84) or radical (RN: n = 92) nephrectomy, with the procedure performed via open, laparoscopic or robot-assisted laparoscopic approaches, depending on tumor characteristics and the results of the preoperative multidisciplinary evaluation. PN was prioritized for localized lesions when technically feasible, while RN was reserved for advanced or centrally located tumors. Patients deemed unsuitable for curative resection due to extensive local invasion or metastatic burden underwent palliative nephrectomy following consensus from a multidisciplinary tumor board. Observation indicators and evaluation criteria Comprehensive clinical data were systematically collected, including demographic parameters (gender, age at diagnosis and body mass index (BMI)), chief symptoms, American Society of Anesthesiologists (ASA) physical status classification and CCI scores for mortality risk stratification [ 6 ] . Tumor dimensions were recorded as maximal radiographic diameters measured through standardized imaging protocols. Histopathological evaluation followed the 2016 WHO classification system for RCC, with nuclear grading and TNM staging performed according to the AJCC 8th edition (2017) guidelines. Surgical outcomes included procedure-specific complications, which were graded using the Clavien-Dindo classification system [ 7 ] . Follow-up Patient follow-up was conducted through scheduled outpatient visits, supplemented by structured telephone interviews. Surveillance continued until October 2024. The study had two endpoints: 1) overall survival (OS), which was measured from the date of surgical intervention until the date of all-cause mortality or the last confirmed contact; and 2) progression-free survival (PFS), which was calculated from the date of surgery until the date of radiologically verified tumor progression or the final follow-up. Mortality events were rigorously adjudicated by an independent clinical endpoint committee to distinguish between RCC-specific mortality (directly attributable to RCC progression/metastasis) and non-RCC mortality (due to documented alternative causes). Statistical analysis All analyses were performed using SPSS 27.0 (IBM Corp), with additional advanced modeling implemented in R 4.0.4 (R Foundation). Continuous variables conforming to normal distribution were expressed as mean ± standard deviation (SD) and compared using Student's t -test, while non-normally distributed data were analyzed via non-parametric Mann-Whitney U tests. Categorical variables were evaluated through χ² or Fisher's exact tests as appropriate. Survival outcomes were assessed through Kaplan-Meier curves with log-rank testing for group comparisons, supplemented by Cox proportional hazards regression models for univariate and multivariate analyses of prognostic factors. A predictive nomogram integrating independent risk factors was developed using R software. P < 0.05 was statistically significant. Result Clinical Characteristics This study analyzed 176 consecutive RCC patients aged ≥ 75 years (median age 78, range 75–87), comprising 115 males (65.3%) and 61 females (34.7%). The patients' demographics and clinicopathological characteristics are shown in Table 1 . All patients underwent nephrectomy, including 84 partial nephrectomies (47.7%) and 92 radical nephrectomies (52.3%), with no significant age-related differences in surgical approach selection ( P = 0.106). Among these procedures, 140 (79.5%) cases were performed via laparoscopic surgery, while 34 (19.3%) cases utilized robot-assisted laparoscopic techniques. Additionally, 2 (1.1%) cases required open surgical approaches, both of which were conversions from laparoscopic partial nephrectomy. Baseline tumor characteristics were comparable between groups, including similar primary tumor diameters ( p = 0.282). Comorbidities were prevalent (hypertension: 61.6%, n = 109), though the median CCI remained consistent across age subgroups at 1. Pathological staging revealed predominantly localized disease: T1 (67.6%, n = 119), T2 (3.4%, n = 6), T3 (27.8%, n = 49), and T4 (1.1%, n = 2), with limited metastatic involvement (lymph node metastasis: 0.6%, n = 1; distant metastasis: 4.0%, n = 7). The average surgical duration was 150.43 ± 58.00 minutes, and the mean length of postoperative hospitalization was 6.78 ± 5.06 days. Histological subtypes mirrored established RCC distributions: clear cell carcinoma (89.8%, n = 158), papillary RCC (3.4%, n = 6), and chromophobe RCC (2.3%, n = 4) ( P = 0.965 for subtype consistency between groups). These findings align with global geriatric RCC epidemiological patterns while highlighting age-specific management considerations. Severe postoperative complications (Clavien-Dindo grade III-V) occurred in 7 of 176 cases (4.0%). Notably, all three grade III complications occurred in PN patients (ureteral stricture [n = 1] and drainage-requiring effusions [n = 2]), while all 4 grade IV complications were RN-specific (heart failure [n = 3] and pulmonary embolism [n = 1]), all successfully managed with ICU care. Survival Analysis During a median follow-up of 44 months, 37 deaths occurred (21.0%), including 25 RCC-related deaths (14.2%) and 12 non-RCC deaths (6.8%). The octogenarian subgroup (≥ 80 years) exhibited significantly higher non-RCC mortality compared to the 75–79 years cohort (60.0% vs. 22.2%; p = 0.029). Kaplan-Meier survival analysis demonstrated favorable long-term outcomes, with OS rates of 97.3% (1-year), 90.4% (3-year), and 75.2% (5-year). Univariable analysis identified gender, symptomatic presentation, tumor diameter > 4 cm, distant metastasis, surgery, and high nuclear grade (3–4) as significant predictors of OS ( p < 0.05), whereas age, CCI ≥ 3, BMI, Clavien ≥ 3 and histologic subtype showed no significant association (Fig. 2 ). Multivariable Cox regression further established six independent prognostic factors: CCI ≥ 3, symptoms, tumor diameter > 4 cm, distant metastasis, Clavien ≥ 3 and AJCC stage (Table 2 ). Subsequently, a nomogram was developed with a C-index of 0.774 (95% CI: 0.712–0.835), demonstrating good discriminative ability (Fig. 3 ). Table 2 Univariate analysis and multivariate analysis of OS predictors of elderly patients with RCC Characteristics Univariate analysis Multivariate analysis HR 95% CI P value HR 95% CI P value Age(<80 vs.≥80) 0.906 0.434–1.890 0.792 1.102 0.436–2.785 0.838 Gender(male vs. female) 0.390 0.170–0.895 0.026 * 0.661 0.244–1.796 0.417 Symptoms (yes vs. no) 2.339 1.159–4.719 0.018 * 7.324 3.175–16.897 < 0.001 ** CCI ≥ 3 1.517 0.706–3.261 0.286 2.616 1.071–6.391 0.035 * Surgery(PN vs. RN) 2.754 1.288–5.891 0.009 ** 0.726 0.299–1.766 0.481 Pathological type (CCRCC vs. NCCRCC) 0.633 0.194–2.071 0.450 0.563 0.128–2.464 0.445 Nuclear_grade (1,2 vs. 3,4) 0.443 0.223–0.883 0.021 * 0.568 0.273–1.180 0.130 Preoperative metastasis(yes vs. no) 0.052 0.019–0.145 < 0.001 ** 0.041 0.011–0.147 4cm 1.266 1.101–1.455 < 0.001 ** 1.345 1.126–1.607 0.001 ** pAJCC 1 Reference Reference 2 0.151 0.056–0.409 < 0.001 ** 0.039 0.008–0.192 < 0.001 ** 3 0.891 0.205–3.871 0.878 0.069 0.008–0.475 0.007 ** 4 0.224 0.076–0.665 0.007 ** 0.047 0.009–0.224 < 0.001 ** Clavien ≥ 3 1.852 0.567–6.048 0.307 0.268 0.072–0.998 0.050 * PFS analysis demonstrated a 5-year PFS rate of 72.3%. Univariate analysis revealed significant associations between PFS and several clinicopathological factors, including gender, presence of symptoms, tumor size exceeding 4 cm, surgical approach, nuclear grade, and pathological stage (Supplementary Fig. 1). However, multivariate Cox regression analysis demonstrated that only CCI ≥ 3, symptomatic presentation, tumor size > 4 cm, and advanced pathological stage remained independent prognostic factors for PFS (Table 3 ). Table 3 Univariate analysis and multivariate analysis of PFS predictors of elderly patients with RCC Characteristics Univariate analysis Multivariate analysis HR 95% CI P value HR 95% CI P value Age(< 80 vs. ≥80) 0.967 0.870–1.076 0.539 0.962 0.835–1.110 0.598 Gender(M vs. F) 0.446 0.204–0.975 0.043 * 0.513 0.174–1.507 0.225 CCI 1.665 0.821–3.378 0.158 3.657 1.067–12.538 0.039 Symptoms (yes vs. no ) 2.193 1.119–4.296 0.022 * 6.203 2.040–18.857 0.001 Tumor diameter (≤ vs. >4cm) 3.112 1.529–6.335 0.002 ** 5.340 1.881–15.161 0.002 surgery 2.766 1.342–5.702 0.006 ** 0.599 0.192–1.872 0.378 Pathological type (CCRCC vs. NCCRCC) 0.533 0.164–1.736 0.296 1.196 0.203–7.055 0.843 Nuclear grade (1.2 vs. 3,4) 0.404 0.206–0.791 0.008 ** 1.690 0.482–5.927 0.413 pAJCC 1 Reference Reference 2 0.143 0.053–0.388 < 0.001 ** 0.036 0.007–0.197 < 0.001 ** 3 1.030 0.237–4.471 0.969 0.073 0.010–0.557 0.012 * 4 0.221 0.076–0.644 0.006 ** 0.047 0.009–0.250 < 0.001 ** OS overall survival, PFS progression free survival *, a significance level of p < 0.05; **, a significance level of p < 0.01 These findings underscore the critical interplay between tumor biology and comorbidity burden in geriatric RCC outcomes. Discussion The management of RCC in elderly patients poses significant challenges due to advanced age, heightened comorbidity burden, elevated perioperative complication risks, and prolonged recovery periods [ 8 , 9 ] . This study analyzed 176 patients aged ≥ 75 years, stratified into two cohorts (75–79 vs. ≥80 years). Survival analysis revealed comparable 1-year cumulative overall survival rates (97.6% vs. 97.8%) but superior 5-year outcomes in octogenarians (84.2% vs. 73.0%). Notably, the ≥ 80-year cohort exhibited significantly higher non-RCC-related mortality ( p = 0.029), reflecting the cumulative impact of age-related chronic conditions and progressive decline in organ function. Despite these challenges, the favorable long-term survival rates support aggressive surgical intervention for localized RCC across all elderly subgroups. These findings underscore that chronological age alone should not preclude curative-intent surgery, provided comprehensive geriatric assessment and comorbidity optimization are prioritized to mitigate non-oncological mortality risks while achieving oncological control [ 10 ] . This cohort demonstrated a 62% hypertension prevalence with a median CCI score of 1, indicating effective comorbidity control attributable to rigorous preoperative comorbidity optimization protocols. Baseline hypertension and diabetes showed no independent prognostic significance for RCC outcomes consistent with previous epidemiological reports [ 11 ] . A prostate cancer study demonstrates the CCI effectively predicts overall survival and non-cancer mortality in very high-risk patients [ 12 ] . The prognostic significance of the CCI in RCC remains a subject of ongoing debate in contemporary literature. Multivariate Cox regression analysis in one study demonstrated that the AACI score served as an independent prognostic factor for OS ( p = 0.002) [ 13 ] . Horsbøl et al. conducted a nationwide cohort study of 7,894 RCC patients, demonstrating that higher CCI scores independently predicted worse 1- and 5-year survival, regardless of age or temporal improvements in prognosis [ 14 ] . Another study in elderly RCC patients suggested CCI had limited prognostic value, showing similar but non-significant effects across all age groups [ 15 ] . In contrast, our multivariate analysis demonstrated that CCI ≥ 3 served as an independent predictor for both OS and PFS in elderly RCC patients. Our analysis revealed comparable tumor dimensions (p = 0.282) and no significant age-based disparity in surgical approach selection between PN (n = 84) and RN (n = 92) cohorts (p = 0.106), demonstrating that clinical decision-making prioritized tumor complexity over chronological age [ 16 ] . Notably, multivariable Cox regression demonstrated no independent association between surgical approach and OS ( p = 0.481), reinforcing current guidelines advocating nephron-sparing strategies when technically feasible, regardless of patient age. The results highlight that surgical strategy for elderly RCC patients should be determined by precise anatomical assessment rather than age-based generalizations [ 17 ] . This study offers significant clinical insights into the perioperative management of elderly patients with RCC. Although patients aged ≥ 75 years exhibited a higher rate of complications, our data indicates that appropriate perioperative management can achieve favorable surgical outcomes in this population, with serious complications occurring in only 4.0% of cases [ 18 ] . Specifically, partial nephrectomy is predominantly associated with technical complications such as ureteral stenosis, whereas radical nephrectomy is more frequently linked to systemic complications, including heart failure. These findings align with previous research in this field [ 19 , 20 ] . Multivariate analysis identified the occurrence of serious complications as an independent determinant of overall survival; importantly, all such complications were successfully managed. Based on these results, our study advocates for the implementation of a dedicated perioperative care strategy for elderly RCC patients. This strategy should include: 1) A comprehensive preoperative evaluation, with particular emphasis on optimizing cardiovascular function, especially for candidates undergoing radical nephrectomy. 2) Surgical procedure selection that integrates oncological principles with consideration of comorbidities. For example, radical nephrectomy is more often recommended for kidney cancer in patients aged 80 years and over. Importantly, age itself should not preclude surgery with proper perioperative management The study identified CCI ≥ 3, symptoms, tumor diameter > 4 cm, distant metastasis, Clavien ≥ 3 and AJCC stage as independent prognostic factors for OS. Notably, tumors > 4 cm demonstrated strong association with inferior outcomes ( p = 0.001), potentially mediated through increased perirenal infiltration risk or paraneoplastic syndrome induction [ 21 ] . Symptomatic patients exhibited significantly reduced survival compared to incidental diagnoses ( p < 0.001), reflecting delayed detection of advanced disease. Contrary to established literature, age showed no independent prognostic value ( p = 0.838), possibly due to limited age stratification and relatively small cohort size (n = 176). While male gender initially correlated with poorer OS in univariable analysis ( p = 0.026), this association dissipated following multivariable adjustment ( p = 0.417). This finding demonstrates a discrepancy with prior studies investigating [ 22 , 23 ] . Histopathological parameters remain pivotal in RCC prognostication, with our study reaffirming the prognostic significance of nuclear grade ( p = 0.021) and pathological AJCC stage ( p = 0.002) [ 24 , 25 ] . While cRCC consistently demonstrates superior outcomes across studies (5-year OS: 92–95%) [ 26 ] , the prognostic implications of ccRCC and pRCC remain a subject of ongoing debate. A Korean multicenter study (1999–2011) of 2,488 ccRCC versus 192 pRCC patients with localized disease showed no statistically significant differences in 5-year postoperative cancer-specific survival (CSS) or recurrence-free survival (RFS) rates [ 27 ] . Notably, our institutional cohort studies of young RCC patients (n = 214) revealed zero mortality/progression events in chromophobe subtypes, contrasting with the current geriatric cohort (n = 176) where histological subtype showed no survival correlation ( p = 0.682). This discrepancy may reflect either diminished statistical power in elderly subgroups or fundamental biological differences in age-specific tumor behavior, warranting further investigation through multicenter collaborations with standardized molecular profiling. This study has several methodological constraints that warrant consideration. First, the retrospective design introduces potential selection bias, particularly regarding exclusion of high-risk patients deemed ineligible for surgery. Second, the limited cohort size (n = 176) restricts statistical power for analyzing rare events, as evidenced by only 2 T4 cases and 1 nodal metastasis. Third, therapeutic heterogeneity—notably unaccounted variations in adjuvant targeted therapies (e.g., VEGF inhibitors) and immunotherapies (e.g., PD-1/PD-L1 inhibitors)—may confound survival interpretations. These limitations underscore the need for multicenter collaborations to validate prognostic models in geriatric RCC populations. Conclusion This study demonstrates that prognosis in elderly RCC patients is influenced by both tumor biology and comorbidity. When making clinical decisions, the following factors should be prioritized: CCI, tumor burden (> 4 cm), AJCC staging and symptoms. Older patients may still benefit from surgery, with the preferred age for RN being 80 years or older. Future research should focus on developing individualized treatment models through prospective studies and exploring synergistic strategies integrating comorbidity management with multimodal therapies to improve outcomes. Abbreviations Abbreviations Full Form RCC Renal cell carcinoma CCI Charlson Comorbidity Index PN Partial nephrectomy RN Radical nephrectomy BMI Body mass index ASA American Society of Anesthesiologists physical status classification OS Overall survival PFS Progression-free survival SD Standard deviation CCRCC Clear cell renal cell carcinoma PRCC Papillary renal cell carcinoma CRCC Chromophobe renal cell carcinoma Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki as revised in 2013 and its later amendments or comparable ethical standards. The study was approved by Peking University Third Hospital Medical Science Research Ethics Committee (approval no. 582-01). Informed consent was obtained from all individual participants included in the study. Clinical trial number: not applicable. Consent for publication Not applicable. Availability of data and materials wu zhiying. Clinicopathological data on elderly renal cancer patients aged 75 years or older in a single centre from 2012 to 2024.[DS/OL]. V1. Science Data Bank, 2025 https://doi.org/10.57760/sciencedb.26991. The datasets generated during and/or analyzed during the current study are available in the [ScienceDB] repository, [https://www.scidb.cn/s/auimMz]. Competing interests This is the first submission of this manuscript, and no parts of this manuscript are being considered for publication elsewhere. All authors have approved this manuscript. No author has financial or other contractual agreements that might cause conflicts of interest. Authorship Contributions Conceptualization and Methodology: MQ, BW. Data curation: ZW, ZX. Formal analysis: ZW, ZX. Investigation: ZW. Writing – original draft: ZW. Writing – review & editing: MQ, LM. Administrative, technical, or material support: LM, HZ, SZ. Supervision: LM. Funding None Author Disclosure Statements Conflict of interest Zhiying Wu certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Acknowledgements I am grateful to the staff of the Department of Urology, Peking University Third Hospital who gave of their time and expertise. Additionally, I thank Min Qiu for her thoughtful comments on the draft. Finally, I thank my anonymous reviewers for helpful input on the manuscript. References EAU-Guidelines-on-Renal-Cell-Carcinoma-2025. http://uroweb.org/guideline/renalcellcarcinoma/ Han B, Zheng R, Zeng H, et al. 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Characteristics and prognostic value of papillary histologic subtype in nonmetastatic renal cell carcinoma in Korea: a multicenter study. Urol J 2014; 11:1884-90. Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Jan, 2026 Reviews received at journal 23 Nov, 2025 Reviews received at journal 13 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers invited by journal 07 Oct, 2025 Editor invited by journal 26 Aug, 2025 Editor assigned by journal 01 Jul, 2025 Submission checks completed at journal 30 Jun, 2025 First submitted to journal 30 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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09:44:58","extension":"png","order_by":48,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99634,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/8414c9627cd5c36eb68e15e7.png"},{"id":93923158,"identity":"cdca12d6-5bde-4b04-b82e-e064102e4c0b","added_by":"auto","created_at":"2025-10-20 10:00:58","extension":"png","order_by":49,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76061,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/62b7f4546a2a750930b52f61.png"},{"id":93921503,"identity":"bb3ebb4a-873b-434d-90a5-86344d25ce4b","added_by":"auto","created_at":"2025-10-20 09:44:58","extension":"xml","order_by":50,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136054,"visible":true,"origin":"","legend":"","description":"","filename":"d2cc799d56174f9c94ed544714202c9c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/8227a09d061fc77d6f927f47.xml"},{"id":93921494,"identity":"4df63758-f844-4ff2-a187-f60b49518d4f","added_by":"auto","created_at":"2025-10-20 09:44:58","extension":"html","order_by":51,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":149565,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/6dae2ea03cfaaadd2d4c714a.html"},{"id":93921451,"identity":"bc63f416-a031-4854-8d7b-633b0006e568","added_by":"auto","created_at":"2025-10-20 09:44:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80338,"visible":true,"origin":"","legend":"\u003cp\u003eConsolidated Standards of Reporting Trials diagram\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/8e8c189451c3189ea2620cb4.png"},{"id":93921453,"identity":"a36b2d5a-4212-4f9f-838b-8fe6b8c6b15e","added_by":"auto","created_at":"2025-10-20 09:44:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":197532,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival curve in OS of elderly adults with RCC divided \u003cstrong\u003eA \u003c/strong\u003eby pathological stage, \u003cstrong\u003eB \u003c/strong\u003eby tumor diameter, \u003cstrong\u003eC \u003c/strong\u003eby preoperative metastasis and \u003cstrong\u003eD\u003c/strong\u003e by pathological stage\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA \u003c/strong\u003eA statistically significant difference in OS was observed between symptomatic and asymptomatic patient groups (p=0.022). \u003cstrong\u003eB \u003c/strong\u003eSimilarly, patients with tumor diameter \u0026gt;4 cm demonstrated significantly worse OS (p=0.004). \u003cstrong\u003eC \u003c/strong\u003eFurthermore, patients with preoperative metastases demonstrated significantly worse OS (p\u0026lt;0.001). \u003cstrong\u003eD\u003c/strong\u003eLastly, a significant difference in OS was observed among different pathological stages (p\u003cem\u003e \u003c/em\u003e=0.002)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/3035392613f05ff2e1a90769.png"},{"id":93921452,"identity":"80f0b24c-0f88-4d2c-a9a5-88a2c9e01abb","added_by":"auto","created_at":"2025-10-20 09:44:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":211262,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA \u003c/strong\u003eA nomogram predicting the OS of elderly patients with RCC; \u003cstrong\u003eB \u003c/strong\u003eCalibration curve for OS\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/a6b870090d63b8159c02c521.png"},{"id":93924475,"identity":"87a68a42-d125-4727-9da0-e246319fe700","added_by":"auto","created_at":"2025-10-20 10:17:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1623397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/f6663e50-58fc-435b-9de8-08674a2642e0.pdf"},{"id":93921455,"identity":"30627971-f8dc-4fbd-ae4d-5e738b54ae8c","added_by":"auto","created_at":"2025-10-20 09:44:57","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":452557,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-6970338/v1/373449750055bc32cefb4ffb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eRCC, a prevalent malignancy arising from the renal tubular epithelium, accounts for around 3% of all cancers in adults worldwide \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The disease burden in China remains substantial, with epidemiological data from 2022 reporting an estimated 73,700 new cases and 24,000 deaths annually\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Established risk factors include advanced age, tobacco use, obesity, and hypertension, as demonstrated by multiple population-based studies\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The intersection of demographic ageing and the increasing prevalence of metabolic disorders has led to a rising incidence of RCC among elderly populations. Of particular concern is the growing proportion of patients diagnosed at 75 years or older, who often present with more complex comorbidities and higher surgical risks. However, despite this epidemiological shift, there is limited robust evidence regarding survival outcomes and prognostic factors in elderly RCC patients, particularly in the Chinese population \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis single-center retrospective study (2012\u0026ndash;2024) aimed to address the knowledge gap in geriatric RCC research in China by specifically evaluating postoperative survival and perioperative complications in elderly RCC patients (\u0026ge;\u0026thinsp;75 years). Through a systematic evaluation of clinicopathological characteristics and comorbidity profiles, we intend to pinpoint modifiable risk factors that influence OS and PFS in this vulnerable patient group. We expect our findings to inform clinical decision-making and improve risk stratification for elderly RCC patients undergoing surgery.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cb\u003eStudy cohort\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis retrospective analysis included 4,062 consecutive patients with histologically confirmed RCC who underwent surgical intervention at Peking University Third Hospital between January 2012 and April 2024. From this cohort, we identified 176 patients aged 75 years or over at diagnosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), comprising 119 patients (67.6%) aged 75–79 years and 57 patients (32.4%) aged 80 years or over. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative analysis of clinicopathological features in elderly RCC patients: \u0026lt;80 years vs. ≥80 years\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eALL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75–79 years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80-89years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; 18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.5–24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt; 24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eChief symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptomatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLumbago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematuria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExaminations reveal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean duration of symptoms (day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(2-5475)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(2-5475)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(3-3650)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.932\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePrevious history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.349\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.511\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebrovascular disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKidney disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfectious diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers malignancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI ≥ 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eASA classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.124\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eSide\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.456\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eOperation method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.609\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaparoscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRobot-assisted laparoscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpen surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time(min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150.43 ± 58.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e150.49 ± 61.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e150.30 ± 50.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.984\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative hospital stay (day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.78 ± 5.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.01 ± 5.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.31 ± 3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor diameter (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.28 ± 2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.25 ± 2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.33 ± 2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor diameter \u0026gt; 4 cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.545\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eMorphology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.965\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCRCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePRCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eothers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eNuclear grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.749\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003epT classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.585\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epT4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epN classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.488\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epNX/pN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epM classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.580\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epMx/pM0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.552\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePatient status at the last follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLost to follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRCC-deaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-RCC deaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFive-year survival rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eASA\u003c/em\u003e American society of anesthesiologists, \u003cem\u003ePN\u003c/em\u003e partial nephrectomy, \u003cem\u003eRN\u003c/em\u003e radical nephrectomy, \u003cem\u003eCCRCC\u003c/em\u003e clear cell renal cell carcinoma, \u003cem\u003ePRCC\u003c/em\u003e papillary renal cell carcinoma, \u003cem\u003eCRCC\u003c/em\u003e chromophobe renal cell carcinoma\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e All participants voluntarily elected to undergo surgery after providing written informed consent. The study protocol was approved by the Institutional Review Board of Peking University Third Hospital (Approval No. 582-01).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical method\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll patients underwent either partial (PN: n = 84) or radical (RN: n = 92) nephrectomy, with the procedure performed via open, laparoscopic or robot-assisted laparoscopic approaches, depending on tumor characteristics and the results of the preoperative multidisciplinary evaluation. PN was prioritized for localized lesions when technically feasible, while RN was reserved for advanced or centrally located tumors. Patients deemed unsuitable for curative resection due to extensive local invasion or metastatic burden underwent palliative nephrectomy following consensus from a multidisciplinary tumor board.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObservation indicators and evaluation criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eComprehensive clinical data were systematically collected, including demographic parameters (gender, age at diagnosis and body mass index (BMI)), chief symptoms, American Society of Anesthesiologists (ASA) physical status classification and CCI scores for mortality risk stratification \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Tumor dimensions were recorded as maximal radiographic diameters measured through standardized imaging protocols. Histopathological evaluation followed the 2016 WHO classification system for RCC, with nuclear grading and TNM staging performed according to the AJCC 8th edition (2017) guidelines. Surgical outcomes included procedure-specific complications, which were graded using the Clavien-Dindo classification system \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFollow-up\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatient follow-up was conducted through scheduled outpatient visits, supplemented by structured telephone interviews. Surveillance continued until October 2024. The study had two endpoints: 1) overall survival (OS), which was measured from the date of surgical intervention until the date of all-cause mortality or the last confirmed contact; and 2) progression-free survival (PFS), which was calculated from the date of surgery until the date of radiologically verified tumor progression or the final follow-up. Mortality events were rigorously adjudicated by an independent clinical endpoint committee to distinguish between RCC-specific mortality (directly attributable to RCC progression/metastasis) and non-RCC mortality (due to documented alternative causes).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll analyses were performed using SPSS 27.0 (IBM Corp), with additional advanced modeling implemented in R 4.0.4 (R Foundation). Continuous variables conforming to normal distribution were expressed as mean ± standard deviation (SD) and compared using Student's \u003cem\u003et\u003c/em\u003e-test, while non-normally distributed data were analyzed via non-parametric Mann-Whitney U tests. Categorical variables were evaluated through χ² or Fisher's exact tests as appropriate. Survival outcomes were assessed through Kaplan-Meier curves with log-rank testing for group comparisons, supplemented by Cox proportional hazards regression models for univariate and multivariate analyses of prognostic factors. A predictive nomogram integrating independent risk factors was developed using R software. P \u0026lt; 0.05 was statistically significant.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cb\u003eClinical Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study analyzed 176 consecutive RCC patients aged ≥ 75 years (median age 78, range 75–87), comprising 115 males (65.3%) and 61 females (34.7%). The patients' demographics and clinicopathological characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All patients underwent nephrectomy, including 84 partial nephrectomies (47.7%) and 92 radical nephrectomies (52.3%), with no significant age-related differences in surgical approach selection (\u003cem\u003eP\u003c/em\u003e = 0.106). Among these procedures, 140 (79.5%) cases were performed via laparoscopic surgery, while 34 (19.3%) cases utilized robot-assisted laparoscopic techniques. Additionally, 2 (1.1%) cases required open surgical approaches, both of which were conversions from laparoscopic partial nephrectomy. Baseline tumor characteristics were comparable between groups, including similar primary tumor diameters (\u003cem\u003ep\u003c/em\u003e = 0.282). Comorbidities were prevalent (hypertension: 61.6%, \u003cem\u003en\u003c/em\u003e = 109), though the median CCI remained consistent across age subgroups at 1. Pathological staging revealed predominantly localized disease: T1 (67.6%, \u003cem\u003en\u003c/em\u003e = 119), T2 (3.4%, \u003cem\u003en\u003c/em\u003e = 6), T3 (27.8%, \u003cem\u003en\u003c/em\u003e = 49), and T4 (1.1%, \u003cem\u003en\u003c/em\u003e = 2), with limited metastatic involvement (lymph node metastasis: 0.6%, \u003cem\u003en\u003c/em\u003e = 1; distant metastasis: 4.0%, \u003cem\u003en\u003c/em\u003e = 7).\u003c/p\u003e\u003cp\u003eThe average surgical duration was 150.43 ± 58.00 minutes, and the mean length of postoperative hospitalization was 6.78 ± 5.06 days. Histological subtypes mirrored established RCC distributions: clear cell carcinoma (89.8%, \u003cem\u003en\u003c/em\u003e = 158), papillary RCC (3.4%, \u003cem\u003en\u003c/em\u003e = 6), and chromophobe RCC (2.3%, \u003cem\u003en\u003c/em\u003e = 4) (\u003cem\u003eP\u003c/em\u003e = 0.965 for subtype consistency between groups). These findings align with global geriatric RCC epidemiological patterns while highlighting age-specific management considerations.\u003c/p\u003e\u003cp\u003eSevere postoperative complications (Clavien-Dindo grade III-V) occurred in 7 of 176 cases (4.0%). Notably, all three grade III complications occurred in PN patients (ureteral stricture [n = 1] and drainage-requiring effusions [n = 2]), while all 4 grade IV complications were RN-specific (heart failure [n = 3] and pulmonary embolism [n = 1]), all successfully managed with ICU care.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurvival Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring a median follow-up of 44 months, 37 deaths occurred (21.0%), including 25 RCC-related deaths (14.2%) and 12 non-RCC deaths (6.8%). The octogenarian subgroup (≥ 80 years) exhibited significantly higher non-RCC mortality compared to the 75–79 years cohort (60.0% vs. 22.2%; \u003cem\u003ep\u003c/em\u003e = 0.029). Kaplan-Meier survival analysis demonstrated favorable long-term outcomes, with OS rates of 97.3% (1-year), 90.4% (3-year), and 75.2% (5-year).\u003c/p\u003e\u003cp\u003eUnivariable analysis identified gender, symptomatic presentation, tumor diameter \u0026gt; 4 cm, distant metastasis, surgery, and high nuclear grade (3–4) as significant predictors of OS (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05), whereas age, CCI ≥ 3, BMI, Clavien ≥ 3 and histologic subtype showed no significant association (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Multivariable Cox regression further established six independent prognostic factors: CCI ≥ 3, symptoms, tumor diameter \u0026gt; 4 cm, distant metastasis, Clavien ≥ 3 and AJCC stage (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Subsequently, a nomogram was developed with a C-index of 0.774 (95% CI: 0.712–0.835), demonstrating good discriminative ability (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis and multivariate analysis of OS predictors of elderly patients with RCC\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(\u0026lt;80 vs.≥80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.434–1.890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.792\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.436–2.785\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.838\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender(male vs. female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.170–0.895\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.244–1.796\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptoms (yes vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.159–4.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e3.175–16.897\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI ≥ 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.706–3.261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.071–6.391\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery(PN vs. RN)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.288–5.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.299–1.766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological type (CCRCC vs. NCCRCC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.633\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.194–2.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.128–2.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.445\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNuclear_grade (1,2 vs. 3,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.223–0.883\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.273–1.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative metastasis(yes vs. no)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.019–0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.011–0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor diameter \u0026gt; 4cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.101–1.455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e1.126–1.607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epAJCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.056–0.409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.008–0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.205–3.871\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.008–0.475\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.076–0.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.009–0.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClavien ≥ 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.567–6.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e0.072–0.998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.050\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003ePFS analysis demonstrated a 5-year PFS rate of 72.3%. Univariate analysis revealed significant associations between PFS and several clinicopathological factors, including gender, presence of symptoms, tumor size exceeding 4 cm, surgical approach, nuclear grade, and pathological stage (Supplementary Fig.\u0026nbsp;1). However, multivariate Cox regression analysis demonstrated that only CCI ≥ 3, symptomatic presentation, tumor size \u0026gt; 4 cm, and advanced pathological stage remained independent prognostic factors for PFS (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate analysis and multivariate analysis of PFS predictors of elderly patients with RCC\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(\u0026lt; 80 vs. ≥80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.870–1.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.835–1.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.598\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender(M vs. F)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.204–0.975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.043\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.174–1.507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.821–3.378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.067–12.538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptoms (yes vs. no )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.119–4.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e6.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.040–18.857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor diameter (≤ vs. \u0026gt;4cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.529–6.335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e5.340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.881–15.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.342–5.702\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.599\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.192–1.872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.378\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathological type (CCRCC vs. NCCRCC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.164–1.736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.203–7.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNuclear grade (1.2 vs. 3,4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.206–0.791\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e1.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.482–5.927\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.413\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epAJCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.053–0.388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.007–0.197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.237–4.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.969\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.010–0.557\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.076–0.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.009–0.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eOS\u003c/em\u003e overall survival, \u003cem\u003ePFS\u003c/em\u003e progression free survival\u003c/p\u003e\u003cp\u003e*, a significance level of p \u0026lt; 0.05; **, a significance level of p \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eThese findings underscore the critical interplay between tumor biology and comorbidity burden in geriatric RCC outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe management of RCC in elderly patients poses significant challenges due to advanced age, heightened comorbidity burden, elevated perioperative complication risks, and prolonged recovery periods\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. This study analyzed 176 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years, stratified into two cohorts (75\u0026ndash;79 vs. \u0026ge;80 years). Survival analysis revealed comparable 1-year cumulative overall survival rates (97.6% vs. 97.8%) but superior 5-year outcomes in octogenarians (84.2% vs. 73.0%). Notably, the \u0026ge;\u0026thinsp;80-year cohort exhibited significantly higher non-RCC-related mortality (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029), reflecting the cumulative impact of age-related chronic conditions and progressive decline in organ function. Despite these challenges, the favorable long-term survival rates support aggressive surgical intervention for localized RCC across all elderly subgroups. These findings underscore that chronological age alone should not preclude curative-intent surgery, provided comprehensive geriatric assessment and comorbidity optimization are prioritized to mitigate non-oncological mortality risks while achieving oncological control\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis cohort demonstrated a 62% hypertension prevalence with a median CCI score of 1, indicating effective comorbidity control attributable to rigorous preoperative comorbidity optimization protocols. Baseline hypertension and diabetes showed no independent prognostic significance for RCC outcomes consistent with previous epidemiological reports\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. A prostate cancer study demonstrates the CCI effectively predicts overall survival and non-cancer mortality in very high-risk patients\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The prognostic significance of the CCI in RCC remains a subject of ongoing debate in contemporary literature. Multivariate Cox regression analysis in one study demonstrated that the AACI score served as an independent prognostic factor for OS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002)\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Horsb\u0026oslash;l et al. conducted a nationwide cohort study of 7,894 RCC patients, demonstrating that higher CCI scores independently predicted worse 1- and 5-year survival, regardless of age or temporal improvements in prognosis\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Another study in elderly RCC patients suggested CCI had limited prognostic value, showing similar but non-significant effects across all age groups\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In contrast, our multivariate analysis demonstrated that CCI\u0026thinsp;\u0026ge;\u0026thinsp;3 served as an independent predictor for both OS and PFS in elderly RCC patients.\u003c/p\u003e\u003cp\u003eOur analysis revealed comparable tumor dimensions (p\u0026thinsp;=\u0026thinsp;0.282) and no significant age-based disparity in surgical approach selection between PN (n\u0026thinsp;=\u0026thinsp;84) and RN (n\u0026thinsp;=\u0026thinsp;92) cohorts (p\u0026thinsp;=\u0026thinsp;0.106), demonstrating that clinical decision-making prioritized tumor complexity over chronological age\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Notably, multivariable Cox regression demonstrated no independent association between surgical approach and OS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.481), reinforcing current guidelines advocating nephron-sparing strategies when technically feasible, regardless of patient age. The results highlight that surgical strategy for elderly RCC patients should be determined by precise anatomical assessment rather than age-based generalizations\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study offers significant clinical insights into the perioperative management of elderly patients with RCC. Although patients aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years exhibited a higher rate of complications, our data indicates that appropriate perioperative management can achieve favorable surgical outcomes in this population, with serious complications occurring in only 4.0% of cases\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Specifically, partial nephrectomy is predominantly associated with technical complications such as ureteral stenosis, whereas radical nephrectomy is more frequently linked to systemic complications, including heart failure. These findings align with previous research in this field\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Multivariate analysis identified the occurrence of serious complications as an independent determinant of overall survival; importantly, all such complications were successfully managed. Based on these results, our study advocates for the implementation of a dedicated perioperative care strategy for elderly RCC patients. This strategy should include: 1) A comprehensive preoperative evaluation, with particular emphasis on optimizing cardiovascular function, especially for candidates undergoing radical nephrectomy. 2) Surgical procedure selection that integrates oncological principles with consideration of comorbidities. For example, radical nephrectomy is more often recommended for kidney cancer in patients aged 80 years and over. Importantly, age itself should not preclude surgery with proper perioperative management\u003c/p\u003e\u003cp\u003eThe study identified CCI\u0026thinsp;\u0026ge;\u0026thinsp;3, symptoms, tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;4 cm, distant metastasis, Clavien\u0026thinsp;\u0026ge;\u0026thinsp;3 and AJCC stage as independent prognostic factors for OS. Notably, tumors\u0026thinsp;\u0026gt;\u0026thinsp;4 cm demonstrated strong association with inferior outcomes (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), potentially mediated through increased perirenal infiltration risk or paraneoplastic syndrome induction\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Symptomatic patients exhibited significantly reduced survival compared to incidental diagnoses (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001), reflecting delayed detection of advanced disease. Contrary to established literature, age showed no independent prognostic value (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.838), possibly due to limited age stratification and relatively small cohort size (n\u0026thinsp;=\u0026thinsp;176). While male gender initially correlated with poorer OS in univariable analysis ( \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), this association dissipated following multivariable adjustment (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.417). This finding demonstrates a discrepancy with prior studies investigating\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHistopathological parameters remain pivotal in RCC prognostication, with our study reaffirming the prognostic significance of nuclear grade (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021) and pathological AJCC stage (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002)\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. While cRCC consistently demonstrates superior outcomes across studies (5-year OS: 92\u0026ndash;95%)\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, the prognostic implications of ccRCC and pRCC remain a subject of ongoing debate. A Korean multicenter study (1999\u0026ndash;2011) of 2,488 ccRCC versus 192 pRCC patients with localized disease showed no statistically significant differences in 5-year postoperative cancer-specific survival (CSS) or recurrence-free survival (RFS) rates\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Notably, our institutional cohort studies of young RCC patients (n\u0026thinsp;=\u0026thinsp;214) revealed zero mortality/progression events in chromophobe subtypes, contrasting with the current geriatric cohort (n\u0026thinsp;=\u0026thinsp;176) where histological subtype showed no survival correlation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.682). This discrepancy may reflect either diminished statistical power in elderly subgroups or fundamental biological differences in age-specific tumor behavior, warranting further investigation through multicenter collaborations with standardized molecular profiling.\u003c/p\u003e\u003cp\u003eThis study has several methodological constraints that warrant consideration. First, the retrospective design introduces potential selection bias, particularly regarding exclusion of high-risk patients deemed ineligible for surgery. Second, the limited cohort size (n\u0026thinsp;=\u0026thinsp;176) restricts statistical power for analyzing rare events, as evidenced by only 2 T4 cases and 1 nodal metastasis. Third, therapeutic heterogeneity\u0026mdash;notably unaccounted variations in adjuvant targeted therapies (e.g., VEGF inhibitors) and immunotherapies (e.g., PD-1/PD-L1 inhibitors)\u0026mdash;may confound survival interpretations. These limitations underscore the need for multicenter collaborations to validate prognostic models in geriatric RCC populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that prognosis in elderly RCC patients is influenced by both tumor biology and comorbidity. When making clinical decisions, the following factors should be prioritized: CCI, tumor burden (\u0026gt;\u0026thinsp;4 cm), AJCC staging and symptoms. Older patients may still benefit from surgery, with the preferred age for RN being 80 years or older. Future research should focus on developing individualized treatment models through prospective studies and exploring synergistic strategies integrating comorbidity management with multimodal therapies to improve outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Form\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eRCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eRenal cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eCCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eCharlson Comorbidity Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003ePN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003ePartial nephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eRN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eRadical nephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eBody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eAmerican Society of Anesthesiologists \u0026nbsp;physical status classification\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eOverall survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003ePFS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eProgression-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eCCRCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eClear cell renal cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003ePRCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003ePapillary renal cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3689%;\"\u003e\n \u003cp\u003eCRCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67.6311%;\"\u003e\n \u003cp\u003eChromophobe renal cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki as revised in 2013 and its later amendments or comparable ethical standards. The study was approved by Peking University Third Hospital Medical Science Research Ethics Committee (approval no. 582-01). Informed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003ewu zhiying. Clinicopathological data on elderly renal cancer patients aged 75 years or older in a single centre from 2012 to 2024.[DS/OL]. V1. Science Data Bank, 2025 https://doi.org/10.57760/sciencedb.26991.\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available in the [ScienceDB] repository, [https://www.scidb.cn/s/auimMz].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is the first submission of this manuscript, and no parts of this manuscript are being considered for publication elsewhere. All authors have approved this manuscript. No author has financial or other contractual agreements that might cause conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship Contributions\u003c/strong\u003e Conceptualization and\u0026nbsp;Methodology: MQ, BW. Data curation: ZW, ZX. Formal analysis: ZW, ZX. Investigation: ZW. Writing \u0026ndash; original draft: ZW. Writing \u0026ndash; review \u0026amp; editing: MQ, LM. Administrative, technical, or material support: LM, HZ, SZ. Supervision: LM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Disclosure Statements\u0026nbsp;\u003c/strong\u003eConflict of interest Zhiying Wu certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI am grateful to the staff of the Department of Urology, Peking University Third Hospital who gave of their time and expertise. Additionally, I thank Min Qiu for her thoughtful comments on the draft. Finally, I thank my anonymous reviewers for helpful input on the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEAU-Guidelines-on-Renal-Cell-Carcinoma-2025. http://uroweb.org/guideline/renalcellcarcinoma/\u003c/li\u003e\n\u003cli\u003eHan B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent 2024; 4:47-53. https://doi.org/10.1016/j.jncc.2024.01.006. \u003c/li\u003e\n\u003cli\u003eCapitanio U, Bensalah K, Bex A, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol 2019; 75:74-84. https://doi.org/10.1016/j.eururo.2018.08.036.\u003c/li\u003e\n\u003cli\u003eGui CP, Chen YH, Zhao HW, et al. Multimodal recurrence scoring system for prediction of clear cell renal cell carcinoma outcome: a discovery and validation study. 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Laparoscopic partial versus radical nephrectomy for localized renal cell carcinoma over 4 cm. J Cancer Res Clin Oncol 2023; 149:17837-17848. https://doi.org/10.1007/s00432-023-05487-3. Epub 2023 Nov 9. \u003c/li\u003e\n\u003cli\u003eVan Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011; 59:543-52. https://doi.org/10.1016/j.eururo.2010.12.013. Epub 2010 Dec 22. \u003c/li\u003e\n\u003cli\u003eHegemann M, Kroeger N, Stenzl A, Bedke J. Rare and changeable as a chameleon: paraneoplastic syndromes in renal cell carcinoma. World J Urol 2018; 3:849-854. https://doi.org/10.1007/s00345-018-2215-9. Epub 2018 Feb 10. \u003c/li\u003e\n\u003cli\u003eFukushima H, Saito K, Yasuda Y, et al. 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The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol 2013; 37:1490-504. https://doi.org/10.1097/PAS.0b013e318299f0fb. \u003c/li\u003e\n\u003cli\u003eWang J, Zhanghuang C, Tan X, et al. Development and Validation of a Competitive Risk Model in Elderly Patients With Chromophobe Cell Renal Carcinoma: A Population-Based Study. Front Public Health 2022; 10:840525. https://doi.org/10.3389/fpubh.2022.840525. \u003c/li\u003e\n\u003cli\u003eLee WK, Lee SE, Hong SK, et al. Characteristics and prognostic value of papillary histologic subtype in nonmetastatic renal cell carcinoma in Korea: a multicenter study. Urol J 2014; 11:1884-90. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Renal cell carcinoma, elderly patients, survival analysis, risk factors, CCI","lastPublishedDoi":"10.21203/rs.3.rs-6970338/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6970338/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eMortality rates for renal cell carcinoma (RCC) are significantly higher among elderly patients than among younger populations. Comorbidities have a substantial influence on the overall prognosis of elderly individuals undergoing RCC treatment. The aim of this study is to identify prognostic factors specific to older adults with RCC.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study enrolled consecutive patients aged 75 years or over with histologically confirmed RCC who were treated at Peking University Third Hospital between January 2012 and December 2024. All participants underwent partial or radical nephrectomy, performed by urological oncology specialists. Adjuvant therapy was administered according to contemporary clinical guidelines. Comprehensive clinicopathological data were systematically collected, including tumor stage (AJCC 8th edition) and histological subtype. Comorbidity burden was objectively assessed using the Charlson Comorbidity Index (CCI), with scores calculated according to standard weighting algorithms. The primary endpoint of the study was all-cause mortality, with follow-up conducted until the end of December 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThis study analyzed 176 consecutive RCC patients aged 75 years or over (median age 78 years, range 75\u0026ndash;87 years), comprising 115 males (65.3%) and 61 females (34.7%). Comorbidities were prevalent, with 61.6% of patients having hypertension and a median CCI score of 1 (range 0\u0026ndash;7). During a median follow-up period of 44 months, there were 37 deaths (21.0% mortality), including 25 cancer-specific deaths (14.2%) and 12 non-oncological deaths (6.8%). Notably, the 80\u0026ndash;87 age subgroup demonstrated significantly lower RCC-associated mortality (p\u0026thinsp;=\u0026thinsp;0.029). Survival rates were 97.3% in one year, 90.4% in three years and 75.2% in five years. CCI\u0026thinsp;\u0026ge;\u0026thinsp;3, symptoms, tumor diameter\u0026thinsp;\u0026gt;\u0026thinsp;4 cm, distant metastasis, Clavien\u0026thinsp;\u0026ge;\u0026thinsp;3 and AJCC stage independently predicted poorer overall survival in geriatric RCC patients. A nomogram with a C-index of 0.774 (95% CI: 0.712\u0026ndash;0.835) was subsequently developed, demonstrating good discriminative ability.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eElderly patients with RCC can still benefit from surgery, and the prognosis is influenced by tumor biology and comorbidities. Partial nephrectomy may be considered on a case-by-case basis for patients over 80 years of age who have limited renal cancer combined with multiple comorbidities.\u003c/p\u003e","manuscriptTitle":"Prognostic Factors Influencing Survival Outcomes in Renal Cell Carcinoma Patients Aged ≥75 Years: A Single-Center Retrospective Cohort Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 09:44:52","doi":"10.21203/rs.3.rs-6970338/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-19T14:53:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-23T22:09:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T13:16:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"586294831205715538809536854080049272","date":"2025-11-04T14:55:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338648999554407636015884695704121077997","date":"2025-11-03T18:39:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-07T19:11:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-26T07:53:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-01T10:01:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T14:37:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-06-30T14:34:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"285c05a4-77eb-44fd-b73e-ba33aa382a0d","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T14:40:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 09:44:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6970338","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6970338","identity":"rs-6970338","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}