World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 15, Number 4, August 2024, pages 625-639

Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis

Figure 1. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram for the systematic review.

Figure 2. Forest plots of perioperative outcomes for LPN vs. LRN. (a) Operative time. (b) Intraoperative blood loss. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; CI: confidence interval; SD: standard deviation.

Figure 3. Forest plot of postoperative complications graded by Clavien-Dindo system. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; CI: confidence interval.

Figure 4. Forest plots of renal function outcomes for LPN vs LRN. (a) eGFR decline. (b) CKD increase. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; CI: confidence interval; SD: standard deviation.

Figure 5. Forest plots of oncological outcomes for LPN vs. LRN. (a) Tumor recurrence (including local recurrence and distant metastasis). (b) Cancer-specific mortality. (c) Overall mortality. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; CI: confidence interval.

**Table 1.** The Baseline Characteristics of Included Studies
Study	Country	Period	Cohort	Cohort size	Age	BMI (kg/m²)	M/F	Tumor side	cT1b	Perioperative eGFR (mL/min)	Perioperative CKD	Follow-up
^aThe original data format is not mean ± standard deviation, and the data in the table are obtained after estimation and adjustment of the original data. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; MIPN: minimally invasive partial nephrectomy; MIRN: minimally invasive radical nephrectomy; RLPN: robotic-assisted laparoscopic partial nephrectomy; RLRN: robotic-assisted laparoscopic radical nephrectomy; BMI: body mass index; R/L: right/left; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; NA: not available; mo: months; yr: years; M/F: male/female.
Simmons et al, 2009 [10]	USA	2001 - 2005	LPN	35	63.5 ± 12	32.1 ± 10	26/9	R22/L13	NA	74 ± 27	III 8/35 (22%)	44 mo
											IV 3/35 (9%)
											V (0)
			LRN	75	63.4 ± 12	29.5 ± 7	39/36	R37/L38	NA	80.4 ± 31	III 17/75 (23%)	57 mo
											IV 1/75 (1%)
											V (0)
Deklaj et al, 2010 [11]	USA	2002 - 2008	LPN	33	59.6 ± 15.0^a	29.0 ± 5.5^a	23/10	NA	33	87.4 ± 39.4	≥ III 6/33 (18%)	15 mo
											V (0)
			LRN	52	64.4 ± 14.5^a	30.0 ± 5.8^a	28/24	NA	52	101.4 ± 41.8	≥ III 13/52 (25%)	21 mo
											V (0)
Brewer et al, 2012 [9]	USA	2004 - 2010	MIPN	45	62.6 ± 15.2	31.5 ± 6.5	28/17	R21/L24	NA	NA	III - IV 16/45 (36%)	NA
			MIRN	108	65.1 ± 13.2	31.4 ± 7.5	69/39	R51/57	NA	NA	III - IV 47/108 (44%)	NA
Cai et al, 2018 [16]	China	2005 - 2012	LPN	39	53 ± 9.0^a	23.55 ± 3.82	26/13	R21/L18	39	78.94 ± 18.74	NA	67 mo
			LRN	160	54 ± 14.8^a	23.25 ± 4.19	97/63	R68/L92	160	85.27 ± 19.87	NA	70 mo
Mizrahi et al, 2018 [12]	Israel	2012 - 2017	LPN	13	NA	NA	8/5	NA	0	NA	NA	44.5 mo
			LRN	16	NA	NA	10/6	NA	0	NA	NA	44.5 mo
Deng et al, 2019 [13]	China	2008 - 2017	RLPN	74	48.5 ± 11.8	NA	41/33	R39/L35	52	85.2 ± 19.6	≥ III 11/74 (14.9%)	41.0 mo
			RLRN	74	48.8 ± 12.5	NA	42/32	R40/L34	53	86.7 ± 18.6	≥ III 9/74 (12.2%)	36.0 mo
Yang et al, 2020 [14]	China	2003 - 2016	LPN	177	56.9 ± 9.81	23.8 ± 2.61	112/65	R89/L88	177	95.3 ± 32.4	≥ III 14/177 (7.9%)	55.0 mo
			LRN	154	57.1 ± 9.62	23.6 ± 2.25	99/55	R75/L79	154	92.6 ± 23.5	≥ III 19/154 (12.3%)	54.7 mo
Yu et al, 2020 [17]	China	NA	LPN	62	49.77 ± 5.58	24.73 ± 4.59	42/20	R34/L28	62	83.07 ± 10.47	NA	60 mo
			LRN	84	50.89 ± 5.78	25.19 ± 3.99	56/28	R44/L40	84	83.56 ± 13.66	NA	60 mo
Sun et al, 2023 [15]	China	2012 - 2017	LPN	51	56.10 ± 14.47	23.77 ± 2.90	32/19	R27/L24	47	74.14 ± 19.18	≥ III 12/51 (23.5%)	7.5 yr
			LRN	51	58.24 ± 13.05	23.98 ± 2.92	36/15	R25/L26	45	74.54 ± 20.24	≥ III 11/51 (21.6%)	7.5 yr

Table 1. The Baseline Characteristics of Included Studies

Study

Country

Period

Cohort

Cohort size

Age

BMI (kg/m²)

M/F

Tumor side

cT1b

Perioperative eGFR (mL/min)

Perioperative CKD

Follow-up

^aThe original data format is not mean ± standard deviation, and the data in the table are obtained after estimation and adjustment of the original data. LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; MIPN: minimally invasive partial nephrectomy; MIRN: minimally invasive radical nephrectomy; RLPN: robotic-assisted laparoscopic partial nephrectomy; RLRN: robotic-assisted laparoscopic radical nephrectomy; BMI: body mass index; R/L: right/left; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; NA: not available; mo: months; yr: years; M/F: male/female.

Simmons et al, 2009 [10]

USA

2001 - 2005

LPN

63.5 ± 12

32.1 ± 10

26/9

R22/L13

74 ± 27

III 8/35 (22%)

44 mo

IV 3/35 (9%)

V (0)

LRN

63.4 ± 12

29.5 ± 7

39/36

R37/L38

80.4 ± 31

III 17/75 (23%)

57 mo

IV 1/75 (1%)

V (0)

Deklaj et al, 2010 [11]

USA

2002 - 2008

LPN

59.6 ± 15.0^a

29.0 ± 5.5^a

23/10

87.4 ± 39.4

≥ III 6/33 (18%)

15 mo

V (0)

LRN

64.4 ± 14.5^a

30.0 ± 5.8^a

28/24

101.4 ± 41.8

≥ III 13/52 (25%)

21 mo

V (0)

Brewer et al, 2012 [9]

USA

2004 - 2010

MIPN

62.6 ± 15.2

31.5 ± 6.5

28/17

R21/L24

III - IV 16/45 (36%)

MIRN

108

65.1 ± 13.2

31.4 ± 7.5

69/39

R51/57

III - IV 47/108 (44%)

Cai et al, 2018 [16]

China

2005 - 2012

LPN

53 ± 9.0^a

23.55 ± 3.82

26/13

R21/L18

78.94 ± 18.74

67 mo

LRN

160

54 ± 14.8^a

23.25 ± 4.19

97/63

R68/L92

160

85.27 ± 19.87

70 mo

Mizrahi et al, 2018 [12]

Israel

2012 - 2017

LPN

8/5

44.5 mo

LRN

10/6

44.5 mo

Deng et al, 2019 [13]

China

2008 - 2017

RLPN

48.5 ± 11.8

41/33

R39/L35

85.2 ± 19.6

≥ III 11/74 (14.9%)

41.0 mo

RLRN

48.8 ± 12.5

42/32

R40/L34

86.7 ± 18.6

≥ III 9/74 (12.2%)

36.0 mo

Yang et al, 2020 [14]

China

2003 - 2016

LPN

177

56.9 ± 9.81

23.8 ± 2.61

112/65

R89/L88

177

95.3 ± 32.4

≥ III 14/177 (7.9%)

55.0 mo

LRN

154

57.1 ± 9.62

23.6 ± 2.25

99/55

R75/L79

154

92.6 ± 23.5

≥ III 19/154 (12.3%)

54.7 mo

Yu et al, 2020 [17]

China

LPN

49.77 ± 5.58

24.73 ± 4.59

42/20

R34/L28

83.07 ± 10.47

60 mo

LRN

50.89 ± 5.78

25.19 ± 3.99

56/28

R44/L40

83.56 ± 13.66

60 mo

Sun et al, 2023 [15]

China

2012 - 2017

LPN

56.10 ± 14.47

23.77 ± 2.90

32/19

R27/L24

74.14 ± 19.18

≥ III 12/51 (23.5%)

7.5 yr

LRN

58.24 ± 13.05

23.98 ± 2.92

36/15

R25/L26

74.54 ± 20.24

≥ III 11/51 (21.6%)

7.5 yr

**Table 2.** The Heterogeneity Test for Baseline Characteristics
Baseline characteristics	LPN vs. LRN	Heterogeneity	Analysis model
LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; WMD: weighted mean difference; OR: odds ratio; CI: confidence interval; BMI: body mass index; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease.
Age WMD (95% CI)	-0.94 (-2.05, 0.18)	2.72	0%	0.91	Random
BMI WMD (95% CI)	0.09 (-0.32, 0.50)	3.66	0%	0.72	Random
Male OR (95% CI)	1.1 (0.86, 1.39)	7.56	0%	0.48	Random
Right side OR (95% CI)	1.15 (0.90, 1.46)	2.44	0%	0.88	Random
cT1b OR (95% CI)	1.05 (0.56, 1.96)	0.45	0%	0.50	Random
Preoperative eGFR WMD (95% CI)	-1.58 (-4.28, 1.13)	6.87	13%	0.33	Random
Preoperative CKD OR (95% CI)	0.91 (0.64, 1.29)	3.27	0%	0.66	Random

Table 2. The Heterogeneity Test for Baseline Characteristics

Baseline characteristics

LPN vs. LRN

Heterogeneity

Analysis model

Chi²

I²

LPN: laparoscopic partial nephrectomy; LRN: laparoscopic radical nephrectomy; WMD: weighted mean difference; OR: odds ratio; CI: confidence interval; BMI: body mass index; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease.

Age WMD (95% CI)

-0.94 (-2.05, 0.18)

2.72

0.91

Random

BMI WMD (95% CI)

0.09 (-0.32, 0.50)

3.66

0.72

Random

Male OR (95% CI)

1.1 (0.86, 1.39)

7.56

0.48

Random

Right side OR (95% CI)

1.15 (0.90, 1.46)

2.44

0.88

Random

cT1b OR (95% CI)

1.05 (0.56, 1.96)

0.45

0.50

Random

Preoperative eGFR WMD (95% CI)

-1.58 (-4.28, 1.13)

6.87

13%

0.33

Random

Preoperative CKD OR (95% CI)

0.91 (0.64, 1.29)

3.27

0.66

Random

**Table 3.** The Risk of Bias Assessment of Each Study by Using the ROBINS-I Tool
Study	Domain 1	Domain 2	Domain 3	Domain 4	Domain 5	Domain 6	Domain 7	Overall
Domain 1: bias due to confounding. Domain 2: bias in selection of participants into the study. Domain 3: bias in classification of interventions. Domain 4: bias due to deviations from intended interventions. Domain 5: bias due to missing data. Domain 6: bias in measurement of outcomes. Domain 7: bias in selection of the reported result. Low risk: the study is judged to be at low risk of bias for all domains. Moderate risk: the study is judged to be at low or moderate risk of bias for all domains. Serious risk: the study is judged to be at serious risk of bias in at least one domain, but not at critical risk of bias in any domain. Critical risk: the study is judged to be at critical risk of bias in at least one domain. No information: there is no clear indication that the study is at serious or critical risk of bias and there is a lack of information in one or more key domains of bias. Low: low risk; Moderate: moderate risk; Serious: serious risk; Critical: critical risk.
Simmons et al, 2009 [10]	Moderate	Moderate	Moderate	Moderate	Moderate	Low	Low	Moderate
Deklaj et al, 2010 [11]	Moderate	Low	Low	Moderate	Low	Low	Moderate	Moderate
Brewer et al, 2012 [9]	Moderate	Moderate	Low	Moderate	Moderate	Moderate	Moderate	Moderate
Cai et al, 2018 [16]	Moderate	Moderate	Low	Moderate	Moderate	Low	Moderate	Moderate
Mizrahi et al, 2018 [12]	Moderate	Moderate	Low	Moderate	Serious	Moderate	Moderate	Serious
Deng et al, 2019 [13]	Moderate	Low	Low	Moderate	Serious	Moderate	Moderate	Serious
Yang et al, 2020 [14]	Moderate	Low	Low	Moderate	Moderate	Low	Moderate	Moderate
Yu et al, 2020 [17]	Moderate	Low	Low	Moderate	Low	Low	Low	Moderate
Sun et al, 2023 [15]	Moderate	Low	Low	Moderate	Low	Low	Low	Moderate

Table 3. The Risk of Bias Assessment of Each Study by Using the ROBINS-I Tool

Study

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Domain 6

Domain 7

Overall

Domain 1: bias due to confounding. Domain 2: bias in selection of participants into the study. Domain 3: bias in classification of interventions. Domain 4: bias due to deviations from intended interventions. Domain 5: bias due to missing data. Domain 6: bias in measurement of outcomes. Domain 7: bias in selection of the reported result. Low risk: the study is judged to be at low risk of bias for all domains. Moderate risk: the study is judged to be at low or moderate risk of bias for all domains. Serious risk: the study is judged to be at serious risk of bias in at least one domain, but not at critical risk of bias in any domain. Critical risk: the study is judged to be at critical risk of bias in at least one domain. No information: there is no clear indication that the study is at serious or critical risk of bias and there is a lack of information in one or more key domains of bias. Low: low risk; Moderate: moderate risk; Serious: serious risk; Critical: critical risk.

Simmons et al, 2009 [10]

Moderate

Low

Moderate

Deklaj et al, 2010 [11]

Moderate

Low

Moderate

Low

Moderate

Brewer et al, 2012 [9]

Moderate

Low

Moderate

Cai et al, 2018 [16]

Moderate

Low

Moderate

Low

Moderate

Mizrahi et al, 2018 [12]

Moderate

Low

Moderate

Serious

Moderate

Serious

Deng et al, 2019 [13]

Moderate

Low

Moderate

Serious

Moderate

Serious

Yang et al, 2020 [14]

Moderate

Low

Moderate

Low

Moderate

Yu et al, 2020 [17]

Moderate

Low

Moderate

Low

Moderate

Sun et al, 2023 [15]

Moderate

Low

Moderate

Low

Moderate

**Table 4.** The Egger’s Test for Effect Sizes
Effect sizes	Intercept	Intercept P value	Slope	Slope P value	Correlation coefficient, r
C-D: Clavien-Dindo system; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease.
Tumor size	-3.130	0.240	0.177	0.631	0.063
Operative time	1.800	0.210	0.501	0.939	0.002
Intraoperative blood loss	3.030	0.027	-2.730	0.539	0.137
Intraoperative complications	1.769	0.376	-0.929	0.48	0.271
Postoperative complications	1.587	0.024	-0.543	0.054	0.488
Postoperative complications (C-D I - II grade)	2.248	0.047	-0.755	0.071	0.717
Postoperative complications (≥ C-D III grade)	1.420	0.301	-1.003	0.426	0.220
eGFR decline	1.360	0.511	9.130	0.202	0.255
CKD	-3.790	0.007	1.110	0.041	0.688
Tumor recurrence	0.625	0.518	-0.278	0.606	0.072
Cancer-specific mortality	0.506	0.359	-0.699	0.172	0.929
Overall mortality	2.351	0.220	-1.075	0.229	0.876

Table 4. The Egger’s Test for Effect Sizes

Effect sizes

Intercept

Intercept P value

Slope

Slope P value

Correlation coefficient, r

C-D: Clavien-Dindo system; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease.

Tumor size

-3.130

0.240

0.177

0.631

0.063

Operative time

1.800

0.210

0.501

0.939

0.002

Intraoperative blood loss

3.030

0.027

-2.730

0.539

0.137

Intraoperative complications

1.769

0.376

-0.929

0.48

0.271

Postoperative complications

1.587

0.024

-0.543

0.054

0.488

Postoperative complications (C-D I - II grade)

2.248

0.047

-0.755

0.071

0.717

Postoperative complications (≥ C-D III grade)

1.420

0.301

-1.003

0.426

0.220

eGFR decline

1.360

0.511

9.130

0.202

0.255

CKD

-3.790

0.007

1.110

0.041

0.688

Tumor recurrence

0.625

0.518

-0.278

0.606

0.072

Cancer-specific mortality

0.506

0.359

-0.699

0.172

0.929

Overall mortality

2.351

0.220

-1.075

0.229

0.876

**Table 5.** Relevant Meta-Analysis Comparing PN and RN
Study	Period	Included studies	Cohort	cT	Perioperative outcomes	Renal function outcomes	Oncological outcomes
EBL: estimated blood loss; NA: not available; WMD: weighted mean differences; CI: confidence interval; OR: odds rate; RR: relative risk; HR: hazard ratio; RFS: recurrence-free survival; PFS: progression-free survival; CSS: cancer-specific survival; CSM: cancer-specific mortality; ACM: all-cause mortality; OS: overall survival; yr: year; PN: partial nephrectomy; RN: radical nephrectomy.
Mir et al, 2016 [20]	1970 - 2011	21	PN: 2,584 vs. RN: 8,620	cT1b - cT2	10.93 min (-17.8, 39.6), P = 0.46	102.61 mL (45.72, 159.49) P = 0.0004	1.74 (1.34, 2.24), P < 0.0001	-8.68 mL/min (-12.62, -4.74), P < 0.0001	0.52 (0.36, 0.76), P = 0.0006	0.6 (0.46, 0.79), P = 0.0002	NA	CSM 0.58 (0.41, 0.81), P = 0.001	ACM 0.67 (0.51, 0.88), P = 0.005
				cT2	NA	107.61 mL (84.46, 130.75), P < 0.00001	2 (1.50, 2.68), P < 0.00001	NA	NA	0.61 (0.44, 0.86), P = 0.004	NA	CSM 0.65 (0.44, 0.97), P = 0.03	ACM 0.76 (0.56, 1.03), P = 0.07
Jiang et al, 2019 [18]	NA	16	PN: 4,176 vs. RN: 21,794	cT1b	NA	NA	1.45 (0.95, 2.21), P = 0.09	-9.15 mL/min (-10.30, -7.99), P < 0.00001	NA	0.68 (0.46, 0.98), P = 0.04	5-yr RFS 0.99 (0.98, 1.01), P = 0.31	5-yr CSS 1.02 (1.01, 1.03), P = 0.0006	5-yr OS 1.02 (1.00, 1.05), P = 0.05
											10-yr RFS 1.00 (0.91, 1.10), P = 0.97	10-yr CSS 1.04 (1.03, 1.06), P < 0.00001	10-yr OS 1.17 (0.95, 1.44), P = 0.13
Deng et al, 2019 [23]	1970 - 2017	12	PN: 1,172 vs. RN: 1,734	≥ cT2	65.33 min (51.93, 78.73), P < 0.00001	97.75 mL (84.65, 110.84), P < 0.00001	2.82 (2.03, 3.93), P < 0.00001	-11.59 mL/min (-9.99, -13.20), P < 0.00001	NA	NA	NA	CSS 0.91, (0.68, 1.21), P = 0.51	OS 0.76 (0.64, 0.90), P = 0.001
Li et al, 2019 [22]	1970 - 2017	11	PN: 1,146 vs. RN: 18,135	≥ cT2	NA	100.44 mL (79.98, 120.90) P < 0.00001	1.96 (1.58, 2.44), P < 0.00001	-9.00 mL/min (-13.72, -4.29), P = 0.0002	NA	0.57 (0.42, 0.75), P < 0.0001	NA	CSM 0.58 (0.39, 0.86), P = 0.007	ACM 0.78 (0.65, 0.92), P = 0.004
Huang et al, 2021 [21]	1970 - 2017	15	PN: 1,975 vs. RN: 3,081	≥ cT2	44.85 min (8.17, 81.52), P = 0.02	103.85 mL (77.13, 130.57), P < 0.00001	2.09 (1.56, 2.80), P < 0.00001	-11.74 mL/min (-13.15, -10.32), P < 0.00001	NA	0.69 (0.53, 0.90), P = 0.007	NA	CSM 1.01 (0.46, 2.19), P = 0.99	OS 0.77 (0.65, 0.90), P = 0.002
												CSS 0.91 (0.68, 1.21), P = 0.51	ACM 0.58 (0.39, 0.88), P = 0.010
Zhang et al, 2021 [19]	1979 - 2014	13	PN: 1,974 vs. RN: 5,091	cT1b	-3.98 min (-14.99, 7.02), P = NA	-16.47 mL (-68.06, 35.13), P = 0.53	1.32 (0.95, 1.84), P = 0.10	-6.60 mL/min (-12.85, -0.35), P = 0.04	0.38 (0.19, 0.76), P = 0.006	0.53 (0.32, 0.86), P = 0.01	PFS 0.70 (0.40, 1.24), P = 0.22	CSS 0.91 (0.66, 1.26), P = 0.57	OS 1.01 (0.81, 1.26), P = 0.96

Table 5. Relevant Meta-Analysis Comparing PN and RN

Study

Period

Included studies

Cohort

Perioperative outcomes

Renal function outcomes

Oncological outcomes

Operative time, WMD (95% CI)

EBL

Complications

eGFR decline

CKD onset

Recurrence

RFS/PFS

CSS/CSM

OS/ACM

WMD (95% CI)

OR (95% CI)

WMD (95% CI)

RR (95% CI)

HR (95% CI)

EBL: estimated blood loss; NA: not available; WMD: weighted mean differences; CI: confidence interval; OR: odds rate; RR: relative risk; HR: hazard ratio; RFS: recurrence-free survival; PFS: progression-free survival; CSS: cancer-specific survival; CSM: cancer-specific mortality; ACM: all-cause mortality; OS: overall survival; yr: year; PN: partial nephrectomy; RN: radical nephrectomy.

Mir et al, 2016 [20]

1970 - 2011

PN: 2,584 vs. RN: 8,620

cT1b - cT2

10.93 min (-17.8, 39.6), P = 0.46

102.61 mL (45.72, 159.49) P = 0.0004

1.74 (1.34, 2.24), P < 0.0001

-8.68 mL/min (-12.62, -4.74), P < 0.0001

0.52 (0.36, 0.76), P = 0.0006

0.6 (0.46, 0.79), P = 0.0002

CSM 0.58 (0.41, 0.81), P = 0.001

ACM 0.67 (0.51, 0.88), P = 0.005

cT2

107.61 mL (84.46, 130.75), P < 0.00001

2 (1.50, 2.68), P < 0.00001

0.61 (0.44, 0.86), P = 0.004

CSM 0.65 (0.44, 0.97), P = 0.03

ACM 0.76 (0.56, 1.03), P = 0.07

Jiang et al, 2019 [18]

PN: 4,176 vs. RN: 21,794

cT1b

1.45 (0.95, 2.21), P = 0.09

-9.15 mL/min (-10.30, -7.99), P < 0.00001

0.68 (0.46, 0.98), P = 0.04

5-yr RFS 0.99 (0.98, 1.01), P = 0.31

5-yr CSS 1.02 (1.01, 1.03), P = 0.0006

5-yr OS 1.02 (1.00, 1.05), P = 0.05

10-yr RFS 1.00 (0.91, 1.10), P = 0.97

10-yr CSS 1.04 (1.03, 1.06), P < 0.00001

10-yr OS 1.17 (0.95, 1.44), P = 0.13

Deng et al, 2019 [23]

1970 - 2017

PN: 1,172 vs. RN: 1,734

≥ cT2

65.33 min (51.93, 78.73), P < 0.00001

97.75 mL (84.65, 110.84), P < 0.00001

2.82 (2.03, 3.93), P < 0.00001

-11.59 mL/min (-9.99, -13.20), P < 0.00001

CSS 0.91, (0.68, 1.21), P = 0.51

OS 0.76 (0.64, 0.90), P = 0.001

Li et al, 2019 [22]

1970 - 2017

PN: 1,146 vs. RN: 18,135

≥ cT2

100.44 mL (79.98, 120.90) P < 0.00001

1.96 (1.58, 2.44), P < 0.00001

-9.00 mL/min (-13.72, -4.29), P = 0.0002

0.57 (0.42, 0.75), P < 0.0001

CSM 0.58 (0.39, 0.86), P = 0.007

ACM 0.78 (0.65, 0.92), P = 0.004

Huang et al, 2021 [21]

1970 - 2017

PN: 1,975 vs. RN: 3,081

≥ cT2

44.85 min (8.17, 81.52), P = 0.02

103.85 mL (77.13, 130.57), P < 0.00001

2.09 (1.56, 2.80), P < 0.00001

-11.74 mL/min (-13.15, -10.32), P < 0.00001

0.69 (0.53, 0.90), P = 0.007

CSM 1.01 (0.46, 2.19), P = 0.99

OS 0.77 (0.65, 0.90), P = 0.002

CSS 0.91 (0.68, 1.21), P = 0.51

ACM 0.58 (0.39, 0.88), P = 0.010

Zhang et al, 2021 [19]

1979 - 2014

PN: 1,974 vs. RN: 5,091

cT1b

-3.98 min (-14.99, 7.02), P = NA

-16.47 mL (-68.06, 35.13), P = 0.53

1.32 (0.95, 1.84), P = 0.10

-6.60 mL/min (-12.85, -0.35), P = 0.04

0.38 (0.19, 0.76), P = 0.006

0.53 (0.32, 0.86), P = 0.01

PFS 0.70 (0.40, 1.24), P = 0.22

CSS 0.91 (0.66, 1.26), P = 0.57

OS 1.01 (0.81, 1.26), P = 0.96