Evolving Trends and Clinical-Pathological Correlations in Renal Cell Carcinoma Surgery: A Decade-Long Study at Peking University First Hospital

Evolving Trends and Clinical-Pathological Correlations in Renal Cell Carcinoma Surgery: A Decade-Long Study at Peking University First Hospital | 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 Evolving Trends and Clinical-Pathological Correlations in Renal Cell Carcinoma Surgery: A Decade-Long Study at Peking University First Hospital Ke Hu, Ming-Wei Ma, Kai-Wei Yang, Hong-Zhen Li, Xiao-Ying Li, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6346244/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Aug, 2025 Read the published version in Clinical and Experimental Medicine → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose This study aimed to comprehensively delineate the clinical characteristics, surgical interventions, and evolving trends over the past decade among patients undergoing surgery for renal cell carcinoma (RCC). Methods A retrospective analysis was conducted on the clinical records of 9,110 patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital between January 2013 and December 2022. Statistical analyses were performed using SPSS 21.0 software. Categorical variables were analyzed using the Chi-square test or Fisher's exact test, as appropriate. Numerical variables were assessed using the t-test or analysis of variance (ANOVA) for normally distributed data, while non-parametric tests were employed for non-normally distributed numerical variables or ordinal data. A p-value of less than 0.05 was considered statistically significant. Results The study cohort consisted of 6,416 males (70.4%) and 2,694 females (29.6%), with a median age of 55 years. Clear cell renal cell carcinoma (ccRCC) was the most prevalent histological subtype (87.6%), followed by chromophobe renal cell carcinoma (chRCC) (5.1%), papillary renal cell carcinoma (pRCC) (3.7%), and other subtypes (3.6%). Non-ccRCC patients exhibited a significantly higher proportion of advanced T3 + disease staging (19.4% vs. 15%, P < 0.001). Female patients demonstrated higher incidences of both non-ccRCC and special pathology types ( P < 0.001), while non-ccRCC and advanced T-stage disease were more common in pediatric patients ( P < 0.001) and were more likely to undergo radical nephrectomy ( P < 0.001). Over the span of a decade, the demographic characteristics of RCC patients remained relatively stable; however, there was a notable decrease in tumor size over time ( P < 0.001). Notably, partial nephrectomy rates surged between 2013 and 2016—reflecting growing acceptance of nephron-sparing techniques—but later balanced with radical nephrectomies as stricter selection criteria emerged, highlighting the dynamic evolution of RCC surgical management. Conclusion Our study reveals dynamic shifts in RCC management over the past decade, marked by evolving surgical practices and a trend toward smaller tumor sizes at diagnosis, while distinct clinical features in pediatric patients underscore the need for continued refinement of early detection. Renal cell carcinoma Surgery Pathology Decade-long study Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Renal cell carcinoma (RCC) is a significant malignancy that arises from the epithelial lining of the renal tubules. Within the spectrum of urinary tract malignancies encountered in clinical practice, RCC accounts for approximately 3–5% of all adult cancer diagnoses [ 1 ]. According to data from the Centers for Disease Control and Prevention (CDC) in the United States, as well as epidemiological studies conducted in our country, RCC ranks as the third most common tumor in the urinary system, following bladder and prostate cancers in terms of prevalence [ 2 ]. However, in the Beijing region, RCC surpasses these malignancies, making it the most frequent urinary tract cancer. Renal cell carcinoma (RCC) is a major malignancy that originates from the epithelial lining of the renal tubules, accounting for approximately 3–5% of all adult cancers. In both the United States and China, RCC is ranked as the third most common urinary tract malignancy—following bladder and prostate cancers. However, in the Beijing, RCC has emerged as the most frequent urinary tract cancer [ 3 ]. Research from American and European cohorts has consistently demonstrated a higher susceptibility in males, with an approximate male-to-female incidence ratio of 2:1 [ 1 ]. Although the disease can affect individuals across all age groups, it predominantly manifests in those aged between 50 and 70 years. Currently, surgical resection remains the cornerstone of treatment for localized and locally advanced RCC, with prior studies affirming its efficacy and safety profile [ 4 ]. The primary surgical options include partial nephrectomy and radical nephrectomy, selected based on the extent of the disease and individual patient characteristics. To date, however, a comprehensive epidemiological overview detailing the clinical presentation of RCC at diagnosis remains lacking in our country. This gap highlights the urgent need for a thorough investigation into the clinical profiles, pathological features, surgical approaches, and evolving trends associated with RCC. At Peking University First Hospital, which serves as a high-volume center for RCC treatment, an exceptionally large number of cases have been managed over the past decade. This single-center retrospective study reviews the clinical data of 9,110 patients who underwent RCC surgery between January 2013 and December 2022. By comprehensively analyzing clinical characteristics, pathological features, surgical techniques, and their evolution over time, we aim to provide a detailed overview of the current status and emerging trends in RCC management. Materials and Methods 1. Study design and patient cohort This study employed a retrospective cohort design, analyzing data from patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital, between January 2013 and December 2022. Inclusion criteria mandated primary RCC diagnosis confirmed by postoperative pathology following either partial nephrectomy or radical nephrectomy performed within the specified timeframe. Patients were excluded if they presented with recurrent RCC requiring reintervention, had incomplete essential clinical or pathological records, or did not undergo surgical resection as primary treatment. After applying these criteria, a total of 9,110 unique patient cases were included in the final analysis. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of Peking University First Hospital. Informed consent requirements were waived due to the retrospective nature of the analysis and the anonymization of patient data. 2. Data collection and variable definition The dataset was subjected to rigorous statistical analysis, incorporating variables such as patient demographics (age, sex), tumor location, surgical approach, pathological classification, tumor stage and grade, tumor diameter, and disease progression patterns. This comprehensive evaluation aimed to analyze the characteristics and management of RCC within our clinical context. This investigation adheres to the 2016 edition of the World Health Organization (WHO) classification criteria for renal tumors, the eighth edition of the American Joint Committee on Cancer's (AJCC) TNM staging and clinical staging guidelines [ 5 ], and the International Society of Urological Pathology (ISUP) grading system [ 6 ]. 2. Statistical methods Data analysis will be performed using SPSS 21.0 statistical software. Categorical variables will be evaluated employing the chi-square test (or Fisher's Exact Test for small sample sizes), while numerical variables will be analyzed through the t-test or analysis of variance (ANOVA). For variables that do not adhere to a normal distribution or are ordinal in nature, non-parametric testing methods will be applied. A P value of less than 0.05 will be deemed to indicate statistical significance. Results 1. Patients’ characteristics Within the cohort of 9,110 patients included in this study, the median age was determined to be 55 years, with a marked predominance of male participants. The distribution of tumor locations across both kidneys was found to be relatively equitable, and the majority of cases were classified as solitary tumors. Clear cell renal cell carcinoma (ccRCC) constituted the predominant histological subtype, accounting for 87.6% of all cases, while 79.6% of the tumors were categorized as stage T1 according to the TNM staging system. Regarding treatment modalities, the utilization rates of radical nephrectomy and partial nephrectomy were observed to be nearly equivalent. A detailed demographic and clinical characterization of the patient population is presented in Table 1 . Table 1 Characteristic of patient population (N = 9110) Characteristic N (%) Median age(range) 55 (10–95) Gender Male 6416 (70.4) Female 2694 (29.6) Location Left 4406 (48.4) Right 4686 (51.4) Bilateral 18 (0.2) Site One site 8923 (97.9) Two sites 157 (1.7) Multiple sites 30 (0.4) Surgical approach Radical nephrectomy 4359 (47.8) Partial nephrectomy 4751 (52.2) Pathological classification ccRCC 7979 (87.6) chRCC 468 (5.1) pRCC 334 (3.7) TFE-3 related RCC 79 (0.87) Unclassified RCC 65 (0.7) ccpRCC 21 (0.02) Others 164 (1.8) T stage T1 7250 (79.6) T2 355 (3.9) T3 1366 (15.0) T4 30 (0.3) Tx 109 (1.2) G grade G1 4330 (47.5) G2 3468 (38.1) G3 706 (7.7) G4 60 (0.7) Gx 546 (6.0) Sarcomatoid differentiation Yes 202 (2.2) No 8908 (97.8) Necrosis Yes 1175 (12.9) No 7935 (87.1) Venous tumor thrombus Yes 182 (2.0) No 8928 (98.0) * ccRCC, clear cell renal cell carcinoma; chRCC, chromophobe renal cell carcinoma; pRCC, papillary renal cell carcinoma; ccpRCC, clear cell papillary renal cell carcinoma. 2. Decadal trend analysis 2.1 Variability in the number of surgical procedures Over the past decade, there had been a consistent increase in the number of patients eligible for nephrectomy, indicating a rising demand for surgical interventions. Notably, the year 2020 showed deviations primarily attributable to the effects of the global health crisis. However, beginning in 2019, the annual number of individuals undergoing surgery had consistently exceeded one thousand cases (Fig. 1). 2.2 Alterations in age and gender The median age of onset for operable RCC had remained stable, falling within the range of 54 to 57 years. A longitudinal analysis conducted over the past decade, with a focus on the median age, reveals no discernible trend toward either younger or older ages among patients undergoing surgical treatment for RCC. This consistency indicated that the demographic profile of individuals requiring surgical intervention for RCC had largely remained unchanged during the observed period (Fig. 2). A trend analysis was performed to evaluate the age distribution of 9,110 RCC patients across five distinct biennial periods: 2013–2014, 2015–2016, 2017–2018, 2019–2020, and 2021–2022. The analysis demonstrated that the median age of patients varied slightly, ranging between 55 and 57 years across these intervals. However, this fluctuation was not statistically significant ( P = 0.225), suggesting that the age distribution of patients undergoing surgical treatment for RCC has remained relatively stable over the examined decade (Table 2 ). Table 2 Comparison of the age composition of RCC patients in five periods. Under 18 18–64 Over 65 χ2 P N Ratio/% N Ratio/% N Ratio/% 2013–2014 (N = 1407) 2 0.2 1108 78.7 297 21.1 10.615 0.225 2015–2016 (N = 1734) 5 0.3 1370 79.0 359 20.7 2017–2018 (N = 1924) 5 0.3 1472 76.5 447 23.2 2019–2020 (N = 1908) 4 0.2 1440 75.5 464 24.3 2021–2022 (N = 2137) 3 0.2 1659 77.6 475 22.2 * RCC, renal cell carcinoma. A trend analysis was performed to evaluate the age distribution of 9,110 RCC patients across five distinct biennial periods: 2013–2014, 2015–2016, 2017–2018, 2019–2020, and 2021–2022. The analysis demonstrated that the median age of patients varied slightly, ranging between 55 and 57 years across these intervals. However, this fluctuation was not statistically significant ( P = 0.225), suggesting that the age distribution of patients undergoing surgical treatment for RCC has remained relatively stable over the examined decade (Table 2 ). 2.3 Surgical approaches Between 2013 and 2015, a marked preference for partial nephrectomy was observed, with approximately 70% of patients opting for this surgical approach. Following this period, the proportion of partial nephrectomies underwent a gradual decline, characterized by intermittent fluctuations. Currently, the distribution between partial nephrectomy and radical nephrectomy has reached a state of equilibrium (Fig. 3). 2.4 T stages Decade-long post-operative pathological analyses consistently demonstrated a predominant prevalence of T1 stage tumors, accounting for 78.0–84.2% of all cases. In contrast, T2, T3, and T4 stage tumors were significantly less frequent, representing 3.2–5.6%, 10.9–19.1%, and 0–0.8% of cases, respectively (Fig. 4). Over this ten-year timeframe, the proportional distribution of T stages exhibited some variability. However, this fluctuation did not follow any clear or consistent trend (Table 3 ). Table 3 Comparison of the T stages of RCC patients in five periods. T1 + T2 T3 + T4 χ2 P N Ratio/% N Ratio/% 2013–2014 (N = 1392) 1232 87.5 160 11.5 32.628 0.000 2015–2016 (N = 1718) 1439 83.8 279 16.2 2017–2018 (N = 1903) 1612 84.7 291 15.3 2019–2020 (N = 1873) 1524 81.4 349 18.6 2021–2022 (N = 2110) 1797 85.1 313 14.9 * RCC, renal cell carcinoma. 2.5 Tumor diameters In the assessment of trends in average tumor diameters among patients with RCC undergoing surgical intervention, stratified into five-year intervals, the mean tumor diameters for the periods 2013–2014, 2015–2016, 2017–2018, 2019–2020, and 2021–2022 were recorded as (4.21 ± 2.47) cm, (4.38 ± 2.37) cm, (4.16 ± 2.28) cm, (4.05 ± 2.35) cm, and (3.83 ± 2.37) cm, respectively. These data indicated a noticeable trend of gradual reduction in tumor diameters over time among RCC patients undergoing surgery during the past decade, with statistically significant differences ( P < 0.001) (Fig. 5). 2.6 Pathological classifications Over the past decade, ccRCC had predominated in the pathological classification of RCC, accounting for 86.3–89.7% of all diagnosed cases (Fig. 6). Notably, the proportion of pathological subtypes among patients undergoing surgical treatment for RCC had remained remarkably consistent, with no significant variations observed in the distribution of these classifications ( P = 0.162) (Table 4 ). Table 4 Comparison of the pathological classifications of RCC patients in five periods. ccRCC pRCC chRCC Others χ2 P N Ratio/% N Ratio/% N Ratio/% N Ratio/% 2013–2014 (N = 1407) 1232 87.6 49 3.5 76 5.4 50 3.5 16.691 0.162 2015–2016 (N = 1734) 1506 86.9 59 3.4 85 5.0 84 4.7 2017–2018 (N = 1924) 1679 87.3 77 4.0 110 5.7 58 3.0 2019–2020 (N = 1908) 1694 88.8 65 3.4 82 4.3 67 3.5 2021–2022 (N = 2137) 1868 87.4 84 3.9 115 5.4 70 3.3 * RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma; pRCC, papillary renal cell carcinoma; chRCC, chromophobe renal cell carcinoma. 3. Correlation between demographic characteristics and postoperative pathological outcomes 3.1 Gender The analysis of gender-based differences in surgical approaches and subsequent pathological findings uncovered significant distinctions. A markedly higher percentage of female patients underwent radical nephrectomy compared to male patients, with this difference being statistically significant ( P < 0.001). Additionally, a notable association was observed between gender and the prevalence of specific pathological subtypes of RCC, with a significantly greater proportion affecting female patients ( P < 0.001). However, no significant gender-related differences were detected regarding the number of primary lesions ( P = 0.394) or T-stage classification ( P = 0.165) (Table 5 ). Table 5 Gender-based comparison of surgical method, number of primary lesions, pathological types, and T staging in RCC Patients. Male (N = 6416) Female (N = 2694) χ2 P Surgical approach Radical nephrectomy N 2927 1432 42.866 0.000 Ratio/% 45.6 53.2 Partial nephrectomy N 3489 1262 Ratio/% 54.4 46.8 Primary tumor site One site N 6276 2647 1.861 0.394 Ratio/% 97.8 98.3 Two sites N 117 40 Ratio/% 1.8 1.5 Multiple sites N 23 7 Ratio/% 0.4 0.2 Pathological type ccRCC N 5742 2237 72.194 0.000 Ratio/% 89.5 83.0 Non-ccRCC N 674 457 Ratio/% 10.5 17.0 Male (N = 6343) Female (N = 2658) χ2 P T stage T1 + T2 N 5537 2268 1.926 0.165 Ratio/% 84.1 85.3 T3 + T4 N 1006 390 Ratio/% 15.9 14.7 * RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma. 3.2 Age The patients treated in our center were stratified into three distinct age groups: "Under 18," "18–64," and "65 and older." We conducted an analysis of differences in surgical characteristics and pathological outcomes among these groups. Our comparative findings revealed significant variations in surgical approaches ( P < 0.001), T-stage classification ( P < 0.001), and pathological subtypes ( P < 0.001) across the different age categories. Notably, a higher proportion of patients aged 18–64 underwent partial nephrectomy compared to those aged 65 and older ( P < 0.001). In contrast, among patients under 18, a greater fraction underwent radical nephrectomy and were diagnosed with specific pathological subtypes, which may be associated with more advanced T-stage disease ( P < 0.001). However, the disparity in the number of primary foci among the three age groups did not reach statistical significance ( P = 0.077) (Table 6 ). Table 6 Age-based comparison of surgical method, number of primary lesions, pathological types, and T staging in RCC Patients. Under 18 (N = 19) 18–64 (N = 7049) Over 65 (N = 2042) χ2 P Surgical approach Radical nephrectomy N 15 3209 1135 71.576 0.000 Ratio/% 78.9 45.5 55.6 Partial nephrectomy N 4 3840 907 Ratio/% 21.1 54.5 44.4 Primary tumor site One site N 18 6895 2010 8.443 0.077 Ratio/% 94.7 97.8 98.4 Two sites N 1 125 31 Ratio/% 5.3 1.8 1.5 Multiple sites N 0 29 1 Ratio/% 0.0 0.4 0.1 Pathological type ccRCC N 5 6166 1808 132.594 0.000 Ratio/% 26.3 87.5 88.5 Non-ccRCC N 14 883 234 Ratio/% 73.7 12.5 11.5 Under 18 (N = 19) 18–64 (N = 6970) Over 65 (N = 2012) χ2 P T stage T1 + T2 N 6 6041 1558 142.318 0.000 Ratio/% 31.6 86.7 77.4 T3 + T4 N 13 929 454 Ratio/% 68.4 13.3 22.6 * RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma. 4. Correlation between pathological types, demographic characteristics, and staging The analytical results indicated that the T staging in non-ccRCC cases tends to be more advanced compared to ccRCC ( P < 0.001). Nevertheless, no significant difference was observed in the number of primary lesions across various pathological types ( P = 0.057) (Table 7 ). Table 7 Comparison of the composition ratio of the number of primary lesions and T staging in patients undergoing surgery for different pathological types of RCC. ccRCC (N = 7979) non-ccRCC (N = 1131) χ2 P Primary tumor site One site N 7818 1105 5.742 0.057 Ratio/% 98.0 97.7 Two sites N 139 18 Ratio/% 1.7 1.6 Multiple sites N 22 8 Ratio/% 0.3 0.7 ccRCC (N = 7901) non-ccRCC (N = 1100) χ2 P T stage T1 + T2 N 6718 887 13.873 0.000 Ratio/% 85.0 80.6 T3 + T4 N 1183 213 Ratio/% 15.0 19.4 * RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma. Furthermore, within this cohort, a subset of 79 patients (0.87%) was identified as having Xp11.2 translocation RCC, which belongs to the MiTF/TFE3 family of transcription factor fusion renal tumors. A marked gender disparity was observed, with females constituting the majority at 49 cases (62.0%), compared to males who accounted for 30 cases (38.0%). The median age at diagnosis within this subgroup was 32 years (range: 15–89 years), with a mean age of 35.86 years (standard deviation ± 3.48 years). Notably, the age of onset for patients with Xp11.2 translocation RCC was significantly younger than that of the broader RCC patient population treated at this institution ( P < 0.001). Discussion Drawing on data from 9,110 RCC cases treated at our institution over the past decade—the largest single-center dataset reported to date—this manuscript provides a comprehensive analysis of patient demographics, surgical interventions, temporal trends, and associated prognostic factors. Our medical institution performed approximately 1,000 RCC surgeries annually, a volume that significantly exceeds the combined total of 3,331 surgeries conducted across 15 centers in 10 European countries over a five-year period, as reported by the European Association of Urology [ 7 ]. At our center, the median age at RCC diagnosis is 55 years—a figure that has remained stable over the past decade without a trend toward an older or younger cohort. In contrast, international reports indicate a median age of 64 years [ 8 – 10 ], suggesting that our patient population is relatively younger. This discrepancy may reflect broader variations in demographics and genetic diversity within our country. Furthermore, while data from the American Cancer Society (2023) show that individuals aged 60 and above account for 57.3% of RCC diagnoses globally [ 1 ], only 37.1% of cases at our institution fall into this age group. This difference is likely attributable to surgical contraindications or limited surgical accessibility among older patients. The gender distribution in our patient population demonstrated a male-to-female ratio of 2.38:1, which is consistent with the gender prevalence reported in existing literature [ 1 ]. In our center, ccRCC represented the predominant pathological subtype of RCC, comprising 87.6% of all cases, which is consistent with the proportions reported in previous studies [ 1 , 11 ]. However, the incidence of pRCC, at 343 cases (3.77%), is lower than that reported in earlier literature [ 12 , 13 ]. This discrepancy may be attributed to the significant tumor heterogeneity and the complex nature of the pathological classification of pRCC [ 14 , 15 ]. Historically, pRCC had been clinically classified into Type I and Type II based on cytopathological characteristics [ 14 ]. However, the 2022 WHO classification of renal tumors did not incorporate this dichotomy due to its low interobserver reliability and the difficulty in categorizing certain papillary carcinomas into either type [ 16 ]. Despite this, since the 2022 classification criteria had yet to be universally adopted, our pathology department continued to utilize the original Type I and Type II classification system. This may partially explain the lower reported incidence of pRCC in our data. Consistent with the results of other studies, ChRCC was identified in 468 cases (5.14%) [ 12 , 13 ]. Notably, the proportion of non-ccRCC at stage T3 or higher was significantly greater than that of ccRCC, likely reflecting the generally more aggressive and invasive nature of non-ccRCC subtypes [ 17 – 20 ]. Following the widespread adoption of computerized tomography (CT) scanning for health assessments, our institution conducted a comprehensive analysis of data spanning a decade. This analysis demonstrated a progressive reduction in the maximum tumor diameter among surgical patients, a trend that aligns with findings reported by Junejo et al in 2021 [ 21 ]. The decision to perform partial nephrectomy versus radical nephrectomy is primarily influenced by tumor size. Nevertheless, despite the observed annual decrease in tumor longitudinal dimensions, a direct correlation with the choice of surgical intervention has yet to be established. Notably, over the past decade, there had been a notable shift in the surgical management of RCC at our center. Initially, partial nephrectomies accounted for up to 70% of all procedures. However, this proportion had gradually shifted toward a more balanced distribution with radical nephrectomies over time. Radical nephrectomy, first introduced by Robson in 1963, has traditionally been regarded as the "gold standard" for the surgical treatment of localized RCC [ 22 ]. In contrast, the acceptance of partial nephrectomy as a viable alternative extended over a period of more than 110 years. Although the first partial nephrectomy was performed in 1887, it was not until the publication of extensive long-term follow-up studies by Herr in 1999 [ 23 ] and Hafez in 2000 [ 24 ] that this procedure received widespread endorsement in clinical guidelines and gained recognition within the academic community as a suitable treatment option. The implementation of nephron-sparing surgery (NSS) has gained favor due to its association with a lesser decline in glomerular filtration rate (GFR) and a reduced incidence of chronic kidney disease (CKD). As such, major clinical guidelines designate NSS as the preferred treatment modality for T1a RCC, with limited exceptions for cases involving a solitary kidney, bilateral tumors, or hereditary kidney cancer. However, the application of NSS for T1b and T2 RCC remains controversial, with no clear consensus established [ 25 ]. Recent advancements in robotic surgery, coupled with an increasing patient preference for procedures that prioritize tumor resection while preserving renal function, have encouraged clinicians to investigate the feasibility of NSS in patients with T2 RCC. This shift in approach may account for the observed rise in the proportion of NSS among all surgical interventions between 2013 and 2015. The subsequent development and widespread adoption of the R.E.N.A.L. nephrometry scoring system had facilitated a more prudent and discerning approach to the application of NSS. This underscored the necessity for careful consideration when expanding the surgical indications for NSS [ 26 , 27 ]. As a result, the selection criteria for NSS have become increasingly stringent, which may account for the observed decline in the proportion of NSS procedures performed at our institution. Furthermore, there have been no significant alterations in patient demographics, including age distribution, gender proportions, or pathological subtypes, at the time of surgery over the past decade. Although fluctuations in the proportions of different T stages had been noted, no consistent trends had emerged. These findings suggest that the demographic and pathological profiles of RCC patients treated at our center have remained relatively stable during this period. Upon analyzing the distribution of RCC across different genders and age groups, it had been observed that female patients demonstrated a higher prevalence of rare pathological subtypes of RCC compared to male patients, accompanied by an increased frequency of radical nephrectomy procedures. In pediatric populations, there was a significant rise in the incidence of non-ccRCC, which was characterized by more advanced T-stage classifications and larger tumor dimensions. These factors collectively resulted in a higher probability of requiring radical nephrectomy. These trends may be attributed to the intrinsically higher malignancy, increased invasiveness, and poorer prognosis associated with specific pathological entities, such as collecting duct carcinomas and hereditary RCCs. Genetic mutations implicated in hereditary RCCs, including but not limited to fumarate hydratase (FH) gene defects, MiTF/TFE3-related translocation RCC, succinate dehydrogenase B (SDHB) gene mutations, and SMARCB1 gene abnormalities, were disproportionately observed in younger female patients [ 16 , 19 , 20 , 28 – 31 ]. Despite their relatively low incidence, these distinct pathological subtypes, particularly hereditary cancers, were frequently diagnosed at an advanced stage and exhibit aggressive disease behavior and unfavorable prognostic outcomes. Consequently, they warranted heightened clinical vigilance due to their potentially life-threatening implications. Conclusion This investigation employs a comprehensive dataset obtained from RCC surgeries conducted over a decade at our single-center institution. Notably, the fluctuation in the rate of partial nephrectomies highlights an advancing comprehension of surgical techniques within the medical community. Additionally, specific pathological subtypes of RCC are observed with significant frequency among pediatric patients, who frequently present at advanced disease stages. This emphasizes the pressing need for enhanced early diagnostic efforts. Declarations Author Contribution Ke Hu and Ming-Wei Ma wrote the main manuscript text. Ke Hu and Ming-Wei Ma contributed equally to this work. Kai-Wei Yang, Jia-Yan Li and Xue-Ying Ren collected statistics. Hong-Zhen Li and Xiao-Ying Li revised this work critically for important intellectual content. 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J Urol, 1999. 161 (1): p. 33-4; discussion 34-5. Hafez, K.S., A.F. Fergany, and A.C. Novick, Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol, 1999. 162 (6): p. 1930-3. Campbell, S.C., et al., Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. J Urol, 2021. 206 (2): p. 199-208. Scosyrev, E., et al., Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol, 2014. 65 (2): p. 372-7. Pierorazio, P.M., et al., Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol, 2016. 196 (4): p. 989-99. Malouf, G.G., et al., Transcription factor E3 and transcription factor EB renal cell carcinomas: clinical features, biological behavior and prognostic factors. J Urol, 2011. 185 (1): p. 24-9. Tokuda, N., et al., Collecting duct (Bellini duct) renal cell carcinoma: a nationwide survey in Japan. J Urol, 2006. 176 (1): p. 40-3; discussion 43. Gleeson, J.P., et al., Comprehensive Molecular Characterization and Response to Therapy in Fumarate Hydratase-Deficient Renal Cell Carcinoma. Clin Cancer Res, 2021. 27 (10): p. 2910-2919. Msaouel, P., et al., Comprehensive Molecular Characterization Identifies Distinct Genomic and Immune Hallmarks of Renal Medullary Carcinoma. Cancer Cell, 2020. 37 (5): p. 720-734.e13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Aug, 2025 Read the published version in Clinical and Experimental Medicine → Version 1 posted Editorial decision: Revision requested 04 May, 2025 Reviews received at journal 03 May, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers invited by journal 02 Apr, 2025 Editor assigned by journal 02 Apr, 2025 Submission checks completed at journal 02 Apr, 2025 First submitted to journal 31 Mar, 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6346244","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441990439,"identity":"43b2fb8d-ecb9-4f86-809f-5135efe5333e","order_by":0,"name":"Ke Hu","email":"","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Hu","suffix":""},{"id":441990440,"identity":"11f0d6cb-5b66-4a7f-9480-3ad6eedc54b9","order_by":1,"name":"Ming-Wei Ma","email":"","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Ming-Wei","middleName":"","lastName":"Ma","suffix":""},{"id":441990441,"identity":"15c6d9d8-f0d7-46e4-a2bb-6e56c9fabee6","order_by":2,"name":"Kai-Wei Yang","email":"","orcid":"","institution":"Department of Urology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Kai-Wei","middleName":"","lastName":"Yang","suffix":""},{"id":441990442,"identity":"8b2bf812-ee0a-4153-b6c9-ee147778e93d","order_by":3,"name":"Hong-Zhen Li","email":"","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Hong-Zhen","middleName":"","lastName":"Li","suffix":""},{"id":441990443,"identity":"30031146-27c0-4e66-9fea-5e2d72113f00","order_by":4,"name":"Xiao-Ying Li","email":"","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Xiao-Ying","middleName":"","lastName":"Li","suffix":""},{"id":441990444,"identity":"fdcf6bda-2d71-4c34-94cd-50ac04b12a3c","order_by":5,"name":"Jia-Yan Chen","email":"","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Jia-Yan","middleName":"","lastName":"Chen","suffix":""},{"id":441990446,"identity":"733f0eae-d0be-4a3f-81c0-c98614ab0746","order_by":6,"name":"Xue-Ying Ren","email":"","orcid":"","institution":"Department of Urology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Xue-Ying","middleName":"","lastName":"Ren","suffix":""},{"id":441990447,"identity":"e570db03-9eca-4809-971d-2ff76f103222","order_by":7,"name":"Qi Shen","email":"","orcid":"","institution":"Department of Urology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Shen","suffix":""},{"id":441990448,"identity":"b02ff54c-a969-481b-9c45-cb3a13b3ad0e","order_by":8,"name":"Wei Yu","email":"","orcid":"","institution":"Department of Urology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Yu","suffix":""},{"id":441990451,"identity":"4e3e8ad5-5cab-44d9-b76d-fabf93794191","order_by":9,"name":"Xian-Shu Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYHAC9t9///2XY2NvPkC8HgkeNmZjPp5jCaRpSZwnkaNAnHJ598MHDIB60tsYchgYflRsI6zF8ExaQgJQT24bw9kDjD1nbhOhpSHH4ABQT24bY18CM2MbMVr63xg2APWkszHzGBCnRV4ix5gRqCeBjY1YLQYSz9KYgXoM23jYEg4S5Rf5/uRjIC3y8vMfH3zwo4IYWw4gcQ7gUIRmSwNRykbBKBgFo2BEAwAxMTgRXDb7gAAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing 100034","correspondingAuthor":true,"prefix":"","firstName":"Xian-Shu","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2025-03-31 15:38:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6346244/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6346244/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10238-025-01770-4","type":"published","date":"2025-08-19T16:29:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82055377,"identity":"7d35bc40-49b2-4ad3-a0a0-7b9f9407695d","added_by":"auto","created_at":"2025-05-06 10:23:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":514373,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346244/v1/0c0edeea2afdeb220199f1f6.jpg"},{"id":82055387,"identity":"887acacd-2204-4cd7-9ba0-3a68f528eca4","added_by":"auto","created_at":"2025-05-06 10:23:49","extension":"jpg","order_by":2,"title":"Figure 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4","display":"","copyAsset":false,"role":"figure","size":633469,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346244/v1/f91e2b4ca779150a2bbe3abc.jpg"},{"id":82055366,"identity":"83acb7e8-195f-42b7-a8a6-1a26234a5bc5","added_by":"auto","created_at":"2025-05-06 10:23:47","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":542478,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346244/v1/2e7537d4be61b8e541ee1377.jpg"},{"id":82055367,"identity":"0bdb5b44-93fa-4c88-8fa6-bfe1d7ee4dc0","added_by":"auto","created_at":"2025-05-06 10:23:47","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":623951,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6346244/v1/19faab36cf514384882e8161.jpg"},{"id":89847228,"identity":"3a9111a0-995c-4e15-abed-c73fc7b17bfd","added_by":"auto","created_at":"2025-08-25 16:42:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4776259,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6346244/v1/d58b5c44-b162-475c-9143-be27576fa3d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evolving Trends and Clinical-Pathological Correlations in Renal Cell Carcinoma Surgery: A Decade-Long Study at Peking University First Hospital","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRenal cell carcinoma (RCC) is a significant malignancy that arises from the epithelial lining of the renal tubules. Within the spectrum of urinary tract malignancies encountered in clinical practice, RCC accounts for approximately 3\u0026ndash;5% of all adult cancer diagnoses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to data from the Centers for Disease Control and Prevention (CDC) in the United States, as well as epidemiological studies conducted in our country, RCC ranks as the third most common tumor in the urinary system, following bladder and prostate cancers in terms of prevalence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, in the Beijing region, RCC surpasses these malignancies, making it the most frequent urinary tract cancer. Renal cell carcinoma (RCC) is a major malignancy that originates from the epithelial lining of the renal tubules, accounting for approximately 3\u0026ndash;5% of all adult cancers. In both the United States and China, RCC is ranked as the third most common urinary tract malignancy\u0026mdash;following bladder and prostate cancers. However, in the Beijing, RCC has emerged as the most frequent urinary tract cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research from American and European cohorts has consistently demonstrated a higher susceptibility in males, with an approximate male-to-female incidence ratio of 2:1 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although the disease can affect individuals across all age groups, it predominantly manifests in those aged between 50 and 70 years. Currently, surgical resection remains the cornerstone of treatment for localized and locally advanced RCC, with prior studies affirming its efficacy and safety profile [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The primary surgical options include partial nephrectomy and radical nephrectomy, selected based on the extent of the disease and individual patient characteristics. To date, however, a comprehensive epidemiological overview detailing the clinical presentation of RCC at diagnosis remains lacking in our country. This gap highlights the urgent need for a thorough investigation into the clinical profiles, pathological features, surgical approaches, and evolving trends associated with RCC.\u003c/p\u003e \u003cp\u003eAt Peking University First Hospital, which serves as a high-volume center for RCC treatment, an exceptionally large number of cases have been managed over the past decade. This single-center retrospective study reviews the clinical data of 9,110 patients who underwent RCC surgery between January 2013 and December 2022. By comprehensively analyzing clinical characteristics, pathological features, surgical techniques, and their evolution over time, we aim to provide a detailed overview of the current status and emerging trends in RCC management.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1. Study design and patient cohort\u003c/h2\u003e \u003cp\u003eThis study employed a retrospective cohort design, analyzing data from patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital, between January 2013 and December 2022. Inclusion criteria mandated primary RCC diagnosis confirmed by postoperative pathology following either partial nephrectomy or radical nephrectomy performed within the specified timeframe. Patients were excluded if they presented with recurrent RCC requiring reintervention, had incomplete essential clinical or pathological records, or did not undergo surgical resection as primary treatment. After applying these criteria, a total of 9,110 unique patient cases were included in the final analysis. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and received approval from the Ethics Committee of Peking University First Hospital. Informed consent requirements were waived due to the retrospective nature of the analysis and the anonymization of patient data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Data collection and variable definition\u003c/h3\u003e\n\u003cp\u003eThe dataset was subjected to rigorous statistical analysis, incorporating variables such as patient demographics (age, sex), tumor location, surgical approach, pathological classification, tumor stage and grade, tumor diameter, and disease progression patterns. This comprehensive evaluation aimed to analyze the characteristics and management of RCC within our clinical context. This investigation adheres to the 2016 edition of the World Health Organization (WHO) classification criteria for renal tumors, the eighth edition of the American Joint Committee on Cancer's (AJCC) TNM staging and clinical staging guidelines [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and the International Society of Urological Pathology (ISUP) grading system [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e2. Statistical methods\u003c/h3\u003e\n\u003cp\u003eData analysis will be performed using SPSS 21.0 statistical software. Categorical variables will be evaluated employing the chi-square test (or Fisher's Exact Test for small sample sizes), while numerical variables will be analyzed through the t-test or analysis of variance (ANOVA). For variables that do not adhere to a normal distribution or are ordinal in nature, non-parametric testing methods will be applied. A \u003cem\u003eP\u003c/em\u003e value of less than 0.05 will be deemed to indicate statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1. Patients\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003eWithin the cohort of 9,110 patients included in this study, the median age was determined to be 55 years, with a marked predominance of male participants. The distribution of tumor locations across both kidneys was found to be relatively equitable, and the majority of cases were classified as solitary tumors. Clear cell renal cell carcinoma (ccRCC) constituted the predominant histological subtype, accounting for 87.6% of all cases, while 79.6% of the tumors were categorized as stage T1 according to the TNM staging system. Regarding treatment modalities, the utilization rates of radical nephrectomy and partial nephrectomy were observed to be nearly equivalent. A detailed demographic and clinical characterization of the patient population is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eCharacteristic of patient population (N\u0026thinsp;=\u0026thinsp;9110)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age(range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (10\u0026ndash;95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e6416 (70.4)\u003c/p\u003e \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\u003e2694 (29.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e4406 (48.4)\u003c/p\u003e \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\u003e4686 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8923 (97.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157 (1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4359 (47.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4751 (52.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e7979 (87.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e468 (5.1)\u003c/p\u003e \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\u003e334 (3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTFE-3 related RCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (0.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnclassified RCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eccpRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (0.02)\u003c/p\u003e \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\u003e164 (1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7250 (79.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e355 (3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1366 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e4330 (47.5)\u003c/p\u003e \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\u003e3468 (38.1)\u003c/p\u003e \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\u003e706 (7.7)\u003c/p\u003e \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\u003e60 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e546 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSarcomatoid differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8908 (97.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1175 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7935 (87.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVenous tumor thrombus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8928 (98.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e* ccRCC, clear cell renal cell carcinoma; chRCC, chromophobe renal cell carcinoma; pRCC, papillary renal cell carcinoma; ccpRCC, clear cell papillary renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2. Decadal trend analysis\u003c/h2\u003e \u003cp\u003e2.1 Variability in the number of surgical procedures\u003c/p\u003e \u003cp\u003eOver the past decade, there had been a consistent increase in the number of patients eligible for nephrectomy, indicating a rising demand for surgical interventions. Notably, the year 2020 showed deviations primarily attributable to the effects of the global health crisis. However, beginning in 2019, the annual number of individuals undergoing surgery had consistently exceeded one thousand cases (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e2.2 Alterations in age and gender\u003c/p\u003e \u003cp\u003eThe median age of onset for operable RCC had remained stable, falling within the range of 54 to 57 years. A longitudinal analysis conducted over the past decade, with a focus on the median age, reveals no discernible trend toward either younger or older ages among patients undergoing surgical treatment for RCC. This consistency indicated that the demographic profile of individuals requiring surgical intervention for RCC had largely remained unchanged during the observed period (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eA trend analysis was performed to evaluate the age distribution of 9,110 RCC patients across five distinct biennial periods: 2013\u0026ndash;2014, 2015\u0026ndash;2016, 2017\u0026ndash;2018, 2019\u0026ndash;2020, and 2021\u0026ndash;2022. The analysis demonstrated that the median age of patients varied slightly, ranging between 55 and 57 years across these intervals. However, this fluctuation was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.225), suggesting that the age distribution of patients undergoing surgical treatment for RCC has remained relatively stable over the examined decade (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eComparison of the age composition of RCC patients in five periods.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnder 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e18\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eOver 65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u0026ndash;2014 (N\u0026thinsp;=\u0026thinsp;1407)\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\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e10.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u0026ndash;2016 (N\u0026thinsp;=\u0026thinsp;1734)\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\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u0026ndash;2018 (N\u0026thinsp;=\u0026thinsp;1924)\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\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u0026ndash;2020 (N\u0026thinsp;=\u0026thinsp;1908)\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\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u0026ndash;2022 (N\u0026thinsp;=\u0026thinsp;2137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e* RCC, renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA trend analysis was performed to evaluate the age distribution of 9,110 RCC patients across five distinct biennial periods: 2013\u0026ndash;2014, 2015\u0026ndash;2016, 2017\u0026ndash;2018, 2019\u0026ndash;2020, and 2021\u0026ndash;2022. The analysis demonstrated that the median age of patients varied slightly, ranging between 55 and 57 years across these intervals. However, this fluctuation was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.225), suggesting that the age distribution of patients undergoing surgical treatment for RCC has remained relatively stable over the examined decade (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e2.3 Surgical approaches\u003c/p\u003e \u003cp\u003eBetween 2013 and 2015, a marked preference for partial nephrectomy was observed, with approximately 70% of patients opting for this surgical approach. Following this period, the proportion of partial nephrectomies underwent a gradual decline, characterized by intermittent fluctuations. Currently, the distribution between partial nephrectomy and radical nephrectomy has reached a state of equilibrium (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003e2.4 T stages\u003c/p\u003e \u003cp\u003eDecade-long post-operative pathological analyses consistently demonstrated a predominant prevalence of T1 stage tumors, accounting for 78.0\u0026ndash;84.2% of all cases. In contrast, T2, T3, and T4 stage tumors were significantly less frequent, representing 3.2\u0026ndash;5.6%, 10.9\u0026ndash;19.1%, and 0\u0026ndash;0.8% of cases, respectively (Fig.\u0026nbsp;4). Over this ten-year timeframe, the proportional distribution of T stages exhibited some variability. However, this fluctuation did not follow any clear or consistent trend (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\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\u003eComparison of the T stages of RCC patients in five periods.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u0026ndash;2014 (N\u0026thinsp;=\u0026thinsp;1392)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e32.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u0026ndash;2016 (N\u0026thinsp;=\u0026thinsp;1718)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u0026ndash;2018 (N\u0026thinsp;=\u0026thinsp;1903)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u0026ndash;2020 (N\u0026thinsp;=\u0026thinsp;1873)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u0026ndash;2022 (N\u0026thinsp;=\u0026thinsp;2110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* RCC, renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e2.5 Tumor diameters\u003c/p\u003e \u003cp\u003eIn the assessment of trends in average tumor diameters among patients with RCC undergoing surgical intervention, stratified into five-year intervals, the mean tumor diameters for the periods 2013\u0026ndash;2014, 2015\u0026ndash;2016, 2017\u0026ndash;2018, 2019\u0026ndash;2020, and 2021\u0026ndash;2022 were recorded as (4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47) cm, (4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37) cm, (4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28) cm, (4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35) cm, and (3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37) cm, respectively. These data indicated a noticeable trend of gradual reduction in tumor diameters over time among RCC patients undergoing surgery during the past decade, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;5).\u003c/p\u003e \u003cp\u003e2.6 Pathological classifications\u003c/p\u003e \u003cp\u003eOver the past decade, ccRCC had predominated in the pathological classification of RCC, accounting for 86.3\u0026ndash;89.7% of all diagnosed cases (Fig.\u0026nbsp;6). Notably, the proportion of pathological subtypes among patients undergoing surgical treatment for RCC had remained remarkably consistent, with no significant variations observed in the distribution of these classifications (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.162) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the pathological classifications of RCC patients in five periods.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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 \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eccRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003epRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003echRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u0026ndash;2014 (N\u0026thinsp;=\u0026thinsp;1407)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e16.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u0026ndash;2016 (N\u0026thinsp;=\u0026thinsp;1734)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u0026ndash;2018 (N\u0026thinsp;=\u0026thinsp;1924)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u0026ndash;2020 (N\u0026thinsp;=\u0026thinsp;1908)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u0026ndash;2022 (N\u0026thinsp;=\u0026thinsp;2137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1868\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e* RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma; pRCC, papillary renal cell carcinoma; chRCC, chromophobe renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e3. Correlation between demographic characteristics and postoperative pathological outcomes\u003c/h3\u003e\n\u003cp\u003e3.1 Gender\u003c/p\u003e \u003cp\u003eThe analysis of gender-based differences in surgical approaches and subsequent pathological findings uncovered significant distinctions. A markedly higher percentage of female patients underwent radical nephrectomy compared to male patients, with this difference being statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, a notable association was observed between gender and the prevalence of specific pathological subtypes of RCC, with a significantly greater proportion affecting female patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no significant gender-related differences were detected regarding the number of primary lesions (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.394) or T-stage classification (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.165) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGender-based comparison of surgical method, number of primary lesions, pathological types, and T staging in RCC Patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;6416)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2694)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003cp\u003eapproach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRadical nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e42.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePartial\u003c/p\u003e \u003cp\u003enephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003ePrimary tumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOne site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e1.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTwo sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePathological\u003c/p\u003e \u003cp\u003etype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eccRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e72.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNon-ccRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;6343)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2658)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e1.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.2 Age\u003c/p\u003e \u003cp\u003eThe patients treated in our center were stratified into three distinct age groups: \"Under 18,\" \"18\u0026ndash;64,\" and \"65 and older.\" We conducted an analysis of differences in surgical characteristics and pathological outcomes among these groups.\u003c/p\u003e \u003cp\u003eOur comparative findings revealed significant variations in surgical approaches (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), T-stage classification (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and pathological subtypes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) across the different age categories. Notably, a higher proportion of patients aged 18\u0026ndash;64 underwent partial nephrectomy compared to those aged 65 and older (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, among patients under 18, a greater fraction underwent radical nephrectomy and were diagnosed with specific pathological subtypes, which may be associated with more advanced T-stage disease (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the disparity in the number of primary foci among the three age groups did not reach statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.077) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge-based comparison of surgical method, number of primary lesions, pathological types, and T staging in RCC Patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnder 18\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u0026ndash;64\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7049)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOver 65\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2042)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003cp\u003eapproach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRadical nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e3209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e71.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePartial\u003c/p\u003e \u003cp\u003enephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e3840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003ePrimary tumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOne site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e8.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTwo sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePathological\u003c/p\u003e \u003cp\u003etype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eccRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e132.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNon-ccRCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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\u003e883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\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 \u003cp\u003eUnder 18\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u0026ndash;64\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;6970)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOver 65\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e6041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e142.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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\u003e929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e* RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e4. Correlation between pathological types, demographic characteristics, and staging\u003c/h3\u003e\n\u003cp\u003eThe analytical results indicated that the T staging in non-ccRCC cases tends to be more advanced compared to ccRCC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Nevertheless, no significant difference was observed in the number of primary lesions across various pathological types (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.057) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the composition ratio of the number of primary lesions and T staging in patients undergoing surgery for different pathological types of RCC.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eccRCC\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7979)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003enon-ccRCC\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1131)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003ePrimary tumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOne site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e5.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTwo sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMultiple sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\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 \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eccRCC\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7901)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003enon-ccRCC\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT1\u0026thinsp;+\u0026thinsp;T2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e13.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eT3\u0026thinsp;+\u0026thinsp;T4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRatio/%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* RCC, renal cell carcinoma; ccRCC, clear cell renal cell carcinoma.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurthermore, within this cohort, a subset of 79 patients (0.87%) was identified as having Xp11.2 translocation RCC, which belongs to the MiTF/TFE3 family of transcription factor fusion renal tumors. A marked gender disparity was observed, with females constituting the majority at 49 cases (62.0%), compared to males who accounted for 30 cases (38.0%). The median age at diagnosis within this subgroup was 32 years (range: 15\u0026ndash;89 years), with a mean age of 35.86 years (standard deviation\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48 years). Notably, the age of onset for patients with Xp11.2 translocation RCC was significantly younger than that of the broader RCC patient population treated at this institution (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDrawing on data from 9,110 RCC cases treated at our institution over the past decade\u0026mdash;the largest single-center dataset reported to date\u0026mdash;this manuscript provides a comprehensive analysis of patient demographics, surgical interventions, temporal trends, and associated prognostic factors. Our medical institution performed approximately 1,000 RCC surgeries annually, a volume that significantly exceeds the combined total of 3,331 surgeries conducted across 15 centers in 10 European countries over a five-year period, as reported by the European Association of Urology [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. At our center, the median age at RCC diagnosis is 55 years\u0026mdash;a figure that has remained stable over the past decade without a trend toward an older or younger cohort. In contrast, international reports indicate a median age of 64 years [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], suggesting that our patient population is relatively younger. This discrepancy may reflect broader variations in demographics and genetic diversity within our country. Furthermore, while data from the American Cancer Society (2023) show that individuals aged 60 and above account for 57.3% of RCC diagnoses globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], only 37.1% of cases at our institution fall into this age group. This difference is likely attributable to surgical contraindications or limited surgical accessibility among older patients. The gender distribution in our patient population demonstrated a male-to-female ratio of 2.38:1, which is consistent with the gender prevalence reported in existing literature [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our center, ccRCC represented the predominant pathological subtype of RCC, comprising 87.6% of all cases, which is consistent with the proportions reported in previous studies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, the incidence of pRCC, at 343 cases (3.77%), is lower than that reported in earlier literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This discrepancy may be attributed to the significant tumor heterogeneity and the complex nature of the pathological classification of pRCC [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Historically, pRCC had been clinically classified into Type I and Type II based on cytopathological characteristics [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the 2022 WHO classification of renal tumors did not incorporate this dichotomy due to its low interobserver reliability and the difficulty in categorizing certain papillary carcinomas into either type [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite this, since the 2022 classification criteria had yet to be universally adopted, our pathology department continued to utilize the original Type I and Type II classification system. This may partially explain the lower reported incidence of pRCC in our data. Consistent with the results of other studies, ChRCC was identified in 468 cases (5.14%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Notably, the proportion of non-ccRCC at stage T3 or higher was significantly greater than that of ccRCC, likely reflecting the generally more aggressive and invasive nature of non-ccRCC subtypes [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFollowing the widespread adoption of computerized tomography (CT) scanning for health assessments, our institution conducted a comprehensive analysis of data spanning a decade. This analysis demonstrated a progressive reduction in the maximum tumor diameter among surgical patients, a trend that aligns with findings reported by Junejo et al in 2021 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The decision to perform partial nephrectomy versus radical nephrectomy is primarily influenced by tumor size. Nevertheless, despite the observed annual decrease in tumor longitudinal dimensions, a direct correlation with the choice of surgical intervention has yet to be established. Notably, over the past decade, there had been a notable shift in the surgical management of RCC at our center. Initially, partial nephrectomies accounted for up to 70% of all procedures. However, this proportion had gradually shifted toward a more balanced distribution with radical nephrectomies over time. Radical nephrectomy, first introduced by Robson in 1963, has traditionally been regarded as the \"gold standard\" for the surgical treatment of localized RCC [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In contrast, the acceptance of partial nephrectomy as a viable alternative extended over a period of more than 110 years. Although the first partial nephrectomy was performed in 1887, it was not until the publication of extensive long-term follow-up studies by Herr in 1999 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Hafez in 2000 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] that this procedure received widespread endorsement in clinical guidelines and gained recognition within the academic community as a suitable treatment option. The implementation of nephron-sparing surgery (NSS) has gained favor due to its association with a lesser decline in glomerular filtration rate (GFR) and a reduced incidence of chronic kidney disease (CKD). As such, major clinical guidelines designate NSS as the preferred treatment modality for T1a RCC, with limited exceptions for cases involving a solitary kidney, bilateral tumors, or hereditary kidney cancer. However, the application of NSS for T1b and T2 RCC remains controversial, with no clear consensus established [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Recent advancements in robotic surgery, coupled with an increasing patient preference for procedures that prioritize tumor resection while preserving renal function, have encouraged clinicians to investigate the feasibility of NSS in patients with T2 RCC. This shift in approach may account for the observed rise in the proportion of NSS among all surgical interventions between 2013 and 2015. The subsequent development and widespread adoption of the R.E.N.A.L. nephrometry scoring system had facilitated a more prudent and discerning approach to the application of NSS. This underscored the necessity for careful consideration when expanding the surgical indications for NSS [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. As a result, the selection criteria for NSS have become increasingly stringent, which may account for the observed decline in the proportion of NSS procedures performed at our institution. Furthermore, there have been no significant alterations in patient demographics, including age distribution, gender proportions, or pathological subtypes, at the time of surgery over the past decade. Although fluctuations in the proportions of different T stages had been noted, no consistent trends had emerged. These findings suggest that the demographic and pathological profiles of RCC patients treated at our center have remained relatively stable during this period.\u003c/p\u003e \u003cp\u003eUpon analyzing the distribution of RCC across different genders and age groups, it had been observed that female patients demonstrated a higher prevalence of rare pathological subtypes of RCC compared to male patients, accompanied by an increased frequency of radical nephrectomy procedures. In pediatric populations, there was a significant rise in the incidence of non-ccRCC, which was characterized by more advanced T-stage classifications and larger tumor dimensions. These factors collectively resulted in a higher probability of requiring radical nephrectomy. These trends may be attributed to the intrinsically higher malignancy, increased invasiveness, and poorer prognosis associated with specific pathological entities, such as collecting duct carcinomas and hereditary RCCs. Genetic mutations implicated in hereditary RCCs, including but not limited to fumarate hydratase (FH) gene defects, MiTF/TFE3-related translocation RCC, succinate dehydrogenase B (SDHB) gene mutations, and SMARCB1 gene abnormalities, were disproportionately observed in younger female patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Despite their relatively low incidence, these distinct pathological subtypes, particularly hereditary cancers, were frequently diagnosed at an advanced stage and exhibit aggressive disease behavior and unfavorable prognostic outcomes. Consequently, they warranted heightened clinical vigilance due to their potentially life-threatening implications.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This investigation employs a comprehensive dataset obtained from RCC surgeries conducted over a decade at our single-center institution. Notably, the fluctuation in the rate of partial nephrectomies highlights an advancing comprehension of surgical techniques within the medical community. Additionally, specific pathological subtypes of RCC are observed with significant frequency among pediatric patients, who frequently present at advanced disease stages. This emphasizes the pressing need for enhanced early diagnostic efforts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKe Hu and Ming-Wei Ma wrote the main manuscript text. Ke Hu and Ming-Wei Ma contributed equally to this work. Kai-Wei Yang, Jia-Yan Li and Xue-Ying Ren collected statistics. Hong-Zhen Li and Xiao-Ying Li revised this work critically for important intellectual content. Xian-Shu Gao , Wei Yu and Qi Shen agreed to be accountable for all aspects of the work and ensure that questions related to the accuracy or completeness of any part of the work are appropriately investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSiegel, R.L., et al., \u003cem\u003eCancer statistics, 2023.\u003c/em\u003e CA Cancer J Clin, 2023. \u003cstrong\u003e73\u003c/strong\u003e(1): p. 17-48.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. Male Urologic Cancers. USCS Data Brief, no 21. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020.\u003c/li\u003e\n\u003cli\u003eRongshou, Z., et al., \u003cem\u003eCancer incidence and mortality in China, 2016.\u003c/em\u003e Journal of the National Cancer Center, 2022. \u003cstrong\u003e2\u003c/strong\u003e(1): p. 1-9.\u003c/li\u003e\n\u003cli\u003eBarata, P.C. and B.I. 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DOI: 10.13201/j.issn.1001-1420.2019.01.007.\u003c/li\u003e\n\u003cli\u003eWang Chenqing, Ju Yuquan, Yin Fengyan, et al. \u003cem\u003eSummary and analysis of renal cancer surgery cases over five years at a single center[J].\u003c/em\u003e Journal of Modern Urology, 2021, 26(06):514-518.\u003c/li\u003e\n\u003cli\u003eLinehan, W.M., et al., \u003cem\u003eComprehensive Molecular Characterization of Papillary Renal-Cell Carcinoma.\u003c/em\u003e N Engl J Med, 2016. \u003cstrong\u003e374\u003c/strong\u003e(2): p. 135-45.\u003c/li\u003e\n\u003cli\u003eFlippot, R., et al., \u003cem\u003ePapillary Renal Cell Carcinoma: A Family Portrait.\u003c/em\u003e Eur Urol, 2018. \u003cstrong\u003e73\u003c/strong\u003e(1): p. 79-80.\u003c/li\u003e\n\u003cli\u003eTrpkov, K., et al., \u003cem\u003eNew developments in existing WHO entities and evolving molecular concepts: The Genitourinary Pathology Society (GUPS) update on renal neoplasia.\u003c/em\u003e Mod Pathol, 2021. \u003cstrong\u003e34\u003c/strong\u003e(7): p. 1392-1424.\u003c/li\u003e\n\u003cli\u003eVolpe, A., et al., \u003cem\u003eChromophobe renal cell carcinoma (RCC): oncological outcomes and prognostic factors in a large multicentre series.\u003c/em\u003e BJU Int, 2012. \u003cstrong\u003e110\u003c/strong\u003e(1): p. 76-83.\u003c/li\u003e\n\u003cli\u003eWright, J.L., et al., \u003cem\u003eEffect of collecting duct histology on renal cell cancer outcome.\u003c/em\u003e J Urol, 2009. \u003cstrong\u003e182\u003c/strong\u003e(6): p. 2595-9.\u003c/li\u003e\n\u003cli\u003eBakouny, Z., et al., \u003cem\u003eIntegrative clinical and molecular characterization of translocation renal cell carcinoma.\u003c/em\u003e Cell Rep, 2022. \u003cstrong\u003e38\u003c/strong\u003e(1): p. 110190.\u003c/li\u003e\n\u003cli\u003eLeibovich, B.C., et al., \u003cem\u003eHistological subtype is an independent predictor of outcome for patients with renal cell carcinoma.\u003c/em\u003e J Urol, 2010. \u003cstrong\u003e183\u003c/strong\u003e(4): p. 1309-15.\u003c/li\u003e\n\u003cli\u003eJunejo, N.N., et al., \u003cem\u003eTrends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting.\u003c/em\u003e Urol Ann, 2021. \u003cstrong\u003e13\u003c/strong\u003e(2): p. 111-118.\u003c/li\u003e\n\u003cli\u003eRobson, C.J., \u003cem\u003eRadical nephrectomy for renal cell carcinoma.\u003c/em\u003e J Urol, 1963. \u003cstrong\u003e89\u003c/strong\u003e: p. 37-42.\u003c/li\u003e\n\u003cli\u003eHerr, H.W., \u003cem\u003ePartial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup.\u003c/em\u003e J Urol, 1999. \u003cstrong\u003e161\u003c/strong\u003e(1): p. 33-4; discussion 34-5.\u003c/li\u003e\n\u003cli\u003eHafez, K.S., A.F. 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Novick, \u003cem\u003eNephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging.\u003c/em\u003e J Urol, 1999. \u003cstrong\u003e162\u003c/strong\u003e(6): p. 1930-3.\u003c/li\u003e\n\u003cli\u003eCampbell, S.C., et al., \u003cem\u003eRenal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I.\u003c/em\u003e J Urol, 2021. \u003cstrong\u003e206\u003c/strong\u003e(2): p. 199-208.\u003c/li\u003e\n\u003cli\u003eScosyrev, E., et al., \u003cem\u003eRenal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904.\u003c/em\u003e Eur Urol, 2014. \u003cstrong\u003e65\u003c/strong\u003e(2): p. 372-7.\u003c/li\u003e\n\u003cli\u003ePierorazio, P.M., et al., \u003cem\u003eManagement of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis.\u003c/em\u003e J Urol, 2016. \u003cstrong\u003e196\u003c/strong\u003e(4): p. 989-99.\u003c/li\u003e\n\u003cli\u003eMalouf, G.G., et al., \u003cem\u003eTranscription factor E3 and transcription factor EB renal cell carcinomas: clinical features, biological behavior and prognostic factors.\u003c/em\u003e J Urol, 2011. \u003cstrong\u003e185\u003c/strong\u003e(1): p. 24-9.\u003c/li\u003e\n\u003cli\u003eTokuda, N., et al., \u003cem\u003eCollecting duct (Bellini duct) renal cell carcinoma: a nationwide survey in Japan.\u003c/em\u003e J Urol, 2006. \u003cstrong\u003e176\u003c/strong\u003e(1): p. 40-3; discussion 43.\u003c/li\u003e\n\u003cli\u003eGleeson, J.P., et al., \u003cem\u003eComprehensive Molecular Characterization and Response to Therapy in Fumarate Hydratase-Deficient Renal Cell Carcinoma.\u003c/em\u003e Clin Cancer Res, 2021. \u003cstrong\u003e27\u003c/strong\u003e(10): p. 2910-2919.\u003c/li\u003e\n\u003cli\u003eMsaouel, P., et al., \u003cem\u003eComprehensive Molecular Characterization Identifies Distinct Genomic and Immune Hallmarks of Renal Medullary Carcinoma.\u003c/em\u003e Cancer Cell, 2020. \u003cstrong\u003e37\u003c/strong\u003e(5): p. 720-734.e13.\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":"clinical-and-experimental-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"clem","sideBox":"Learn more about [Clinical and Experimental Medicine](https://www.springer.com/journal/10238)","snPcode":"10238","submissionUrl":"https://submission.nature.com/new-submission/10238/3","title":"Clinical and Experimental Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Renal cell carcinoma, Surgery, Pathology, Decade-long study","lastPublishedDoi":"10.21203/rs.3.rs-6346244/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6346244/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aimed to comprehensively delineate the clinical characteristics, surgical interventions, and evolving trends over the past decade among patients undergoing surgery for renal cell carcinoma (RCC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on the clinical records of 9,110 patients diagnosed with RCC who underwent surgical treatment at Peking University First Hospital between January 2013 and December 2022. Statistical analyses were performed using SPSS 21.0 software. Categorical variables were analyzed using the Chi-square test or Fisher's exact test, as appropriate. Numerical variables were assessed using the t-test or analysis of variance (ANOVA) for normally distributed data, while non-parametric tests were employed for non-normally distributed numerical variables or ordinal data. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study cohort consisted of 6,416 males (70.4%) and 2,694 females (29.6%), with a median age of 55 years. Clear cell renal cell carcinoma (ccRCC) was the most prevalent histological subtype (87.6%), followed by chromophobe renal cell carcinoma (chRCC) (5.1%), papillary renal cell carcinoma (pRCC) (3.7%), and other subtypes (3.6%). Non-ccRCC patients exhibited a significantly higher proportion of advanced T3\u0026thinsp;+\u0026thinsp;disease staging (19.4% vs. 15%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Female patients demonstrated higher incidences of both non-ccRCC and special pathology types (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while non-ccRCC and advanced T-stage disease were more common in pediatric patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and were more likely to undergo radical nephrectomy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Over the span of a decade, the demographic characteristics of RCC patients remained relatively stable; however, there was a notable decrease in tumor size over time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, partial nephrectomy rates surged between 2013 and 2016\u0026mdash;reflecting growing acceptance of nephron-sparing techniques\u0026mdash;but later balanced with radical nephrectomies as stricter selection criteria emerged, highlighting the dynamic evolution of RCC surgical management.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur study reveals dynamic shifts in RCC management over the past decade, marked by evolving surgical practices and a trend toward smaller tumor sizes at diagnosis, while distinct clinical features in pediatric patients underscore the need for continued refinement of early detection.\u003c/p\u003e","manuscriptTitle":"Evolving Trends and Clinical-Pathological Correlations in Renal Cell Carcinoma Surgery: A Decade-Long Study at Peking University First Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 10:23:23","doi":"10.21203/rs.3.rs-6346244/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-04T10:00:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-03T17:21:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328019055533146308529958187454450571459","date":"2025-04-07T12:22:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-02T08:59:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-02T06:15:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T06:10:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical and Experimental Medicine","date":"2025-03-31T15:26:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-and-experimental-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"clem","sideBox":"Learn more about [Clinical and Experimental Medicine](https://www.springer.com/journal/10238)","snPcode":"10238","submissionUrl":"https://submission.nature.com/new-submission/10238/3","title":"Clinical and Experimental Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8dece877-9ed5-41ec-b7af-cf91908dec91","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:36:36+00:00","versionOfRecord":{"articleIdentity":"rs-6346244","link":"https://doi.org/10.1007/s10238-025-01770-4","journal":{"identity":"clinical-and-experimental-medicine","isVorOnly":false,"title":"Clinical and Experimental Medicine"},"publishedOn":"2025-08-19 16:29:35","publishedOnDateReadable":"August 19th, 2025"},"versionCreatedAt":"2025-05-06 10:23:23","video":"","vorDoi":"10.1007/s10238-025-01770-4","vorDoiUrl":"https://doi.org/10.1007/s10238-025-01770-4","workflowStages":[]},"version":"v1","identity":"rs-6346244","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6346244","identity":"rs-6346244","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}