Prognostic impact of nephrectomy and a prediction model for estimating the survival benefit of nephrectomy for patients with clear cell renal cell carcinoma (ccRCC).

Background: The benefit of nephrectomy for all patients with clear cell renal cell carcinoma (ccRCC) remains controversial. This study assessed the impact of nephrectomy on patient prognosis and developed a prognostic model for nephrectomy-treated patients. Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas databases. Propensity score matching (PSM) was implemented, followed by univariate and multivariate survival analyses to compare overall survival (OS) between ccRCC patients treated with and without nephrectomy. Subsequently, we developed and internally validated a nomogram for predicting OS in nephrectomy-treated patients using multivariate Cox regression modeling. Results: OS was significantly better in the nephrectomy group compared to the non-nephrectomy group [hazard ratio (HR) =0.405, 95% confidence interval (CI): 0.382-0.429, P<0.001), with significant benefit observed across all predefined subgroups (all HR <1, P<0.05). Age, gender, tumor stage, tumor-node-metastasis (TNM) stage and differentiation grade were identified as independent risk factors of OS in nephrectomy-treated ccRCC patients. The nomogram incorporating these factors exhibited excellent discrimination, calibration, and clinical utility in training, internal validation, and external test cohorts. Conclusions: Nephrectomy was shown to significantly improve survival in patients with ccRCC. We developed an effective survival prediction model for these patients, which could aid in identifying high-risk individuals and providing a valuable tool for personalized survival assessments.