Long-term recurrence after robot-assisted partial nephrectomy for clinical T1 renal cell carcinoma: clinicopathological insights from over 1,000 patients

Abstract Background We explored the preoperative and postoperative factors associated with recurrence-free survival (RFS) after robot-assisted partial nephrectomy (RAPN) during long-term follow-up. Methods We retrospectively evaluated patients who underwent RAPN for clinical T1 renal cell carcinoma (RCC) between 2013 and 2020. Sequential multivariate Cox models were constructed. Model 1 included preoperative factors alone, and Model 2 included postoperative pathological features. As a post-hoc exploratory analysis, RFS was evaluated based on the cumulative number of factors associated with RFS. Results Of the 1,008 patients analyzed, 67 developed recurrence during a median follow-up of 82.2 months. In Model 1, male sex (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.27–5.22) and tumor size ≥ 40 mm (HR 4.67, 95% CI 2.85–7.66) were associated with shorter RFS. In Model 2, the association between male sex and RFS was attenuated (HR 1.89, 95% CI 0.92–3.86), while tumor size ≥ 40 mm (HR 2.67, 95% CI 1.56–4.56) and lymphovascular invasion (HR 4.94, 95% CI 2.87–8.52) were associated with shorter RFS. Post hoc analysis showed 5-year RFS rates of 98.3%, 93.4%, and 76.1% for patients with zero, one, and two factors, respectively. In the clear cell RCC subgroup, higher Fuhrman grade was also associated with shorter RFS (HR 2.44, 95% CI 1.42–4.19). Conclusions Sequential modeling suggested that the association between male sex and RFS could be explained by postoperative pathological features. Stratification based on the cumulative number of associated factors showed stepwise differences in the 5-year RFS. These findings may inform individualized surveillance after RAPN.