Percutaneous Biopsy and Recurrence Risk in Stage 1 Renal Cancer: A Propensity Score-Matched Cohort Study

Despite the growing incidence of small renal tumors, adoption of percutaneous biopsy remains limited because of concerns about oncologic safety. Lack of robust long-term outcome data further contributes to clinical hesitation regarding routine use. We evaluated the impact of preoperative renal mass biopsy (RMB) on upstaging and recurrence in patients with cT1 renal cell carcinoma (RCC) undergoing definitive surgery.

Retrospective cohort study of 386 consecutive patients who underwent preoperative RMB and 772 propensity score-matched controls who proceeded directly to surgery for cT1 RCC between 2004 and 2022 were compared for recurrence-free survival (RFS) using Kaplan-Meier analysis and Cox proportional hazards regression, and upstaging to perinephric fat invasion by multivariable logistic regression.

Analytical cohort comprised 882 (76.2%) T1a and 276 (23.8%) T1b patients, with 684 (59.1%) after partial nephrectomy and 474 (40.9%) after radical nephrectomy. During a median follow-up of 58 months (interquartile range 39-77), RFS showed no statistically significant difference (5Y RFS 96.7% vs. 97.8%, p = 0.35). Multivariable analysis confirmed RMB was not associated with recurrence (hazard ratio = 0.71, 95% confidence interval 0.34-1.46, p = 0.35). Independent predictors of recurrence included tumor size, nuclear grade, high nephrometry E score and perinephric fat invasion. Likewise, RMB was not associated with upstaging to perinephric fat invasion (odds ratio 1.64, 95% confidence interval 0.78-3.36, p = 0.182). On multivariable analysis, nephrometry E score was the only significant predictor of perinephric fat invasion.

Preoperative biopsy in T1 RCC was not associated with adverse oncologic outcomes, affirming its safety and supporting its utility in the management planning of patients with small renal masses.