Pathologic Upstaging in Local Recurrence After Partial Nephrectomy: Distinct Biologic Behavior and Clinical Prognosis...

This study aimed to investigate the pathologic and clinical features of local recurrence after partial nephrectomy (PN) for renal cell carcinoma (RCC), with particular emphasis on recurrence location and its association with pathologic upstaging and salvage surgical management.

The study retrospectively analyzed 55 patients who experienced ipsilateral local recurrence after PN and subsequently underwent secondary surgical treatment between January 2014 and March 2025. Based on imaging, intraoperative findings, and gross pathology, recurrences were classified as original-site recurrence (tumor bed or resection margin) or non-original-site recurrence (distant ipsilateral renal parenchyma). Baseline characteristics, perioperative variables, pathologic findings at secondary surgery, and renal functional outcomes were compared between the two groups. Pathologic upstaging was defined as a higher pathologic T stage of the recurrent tumor compared with the primary tumor.

Of the 55 patients, 32 (58.2 %) had original-site recurrence, and 23 (41.8 %) had non-original-site recurrence. Baseline demographic and perioperative characteristics at initial surgery were comparable between the groups. However, original-site recurrence was significantly associated with pathologic upstaging compared with non-original-site recurrence (84.3 % vs 21.7 %; p < 0.001). Recurrent tumors in the original-site group also showed more advanced pathologic stage at secondary surgery (p < 0.001). This difference influenced salvage treatment selection (p = 0.003): radical nephrectomy was more frequently performed in the original-site group (81.2 % vs 47.8 %), whereas repeat partial nephrectomy was more common in the non-original-site group (47.8 % vs 9.4 %). Cancer-specific mortality and secondary recurrence were numerically higher in the original-site group, although the differences were not statistically significant. Long-term renal functional outcomes were similar between the groups.

Local recurrence after PN is biologically heterogeneous. Original-site recurrence is strongly associated with pathologic upstaging and more aggressive disease, often requiring radical salvage surgery. In contrast, non-original-site recurrence tends to show less aggressive pathology and may be more suitable for repeat nephron-sparing surgery. Recurrence location may therefore be an important factor in postoperative risk stratification and secondary surgical decision-making.