RÉSUMÉ
Objective:To investigate the influencing factors of postoperative surgical margin, warm ischemia time and severe postoperative complication (MIC) comprehensive outcome in patients with stage T 1b renal cell carcinoma treated with nephron sparing surgery (NSS) and to establish a predictive model. Methods:One hundred and seventy-four patients with stage T 1b renal cell carcinoma treated with NSS were retrospectively chosen in the period from January 2017 to January 2022 in 3201 Hospital. All patients were divided into MIC group ( n=66) and non-MIC group ( n=108) according to whether MIC was achieved after surgery or not. Univariate and multivariate analysis were used to evaluate the independent influencing factors of postoperative MIC comprehensive outcome, and a nomogram prediction model was constructed according to the influencing factors and its predictive value was evaluated using receiver operating characteristic (ROC) curve. Results:There were statistically significant differences in the body mass index ( t=2.81, P=0.006), lesion morphology ( χ2=41.41, P<0.001), hot ischemia time ( t=16.92, P<0.001), creatinine increase within 24 h after surgery ( t=16.79, P<0.001), hemoglobin (Hb) decreased within 24 h after surgery ( t=9.33, P<0.001), perioperative complications ( χ2=21.31, P<0.001), R.E.N.A.L. score ( t=4.74, P<0.001), PADUA score ( t=3.21, P=0.002) and Mayo perirenal adhesion index ( t=22.28, P<0.001) in MIC group and non-MIC group. Multivariate analysis showed that body mass index ( OR=0.31, 95% CI: 0.13-0.74, P=0.007), lesion morphology ( OR=0.36, 95% CI: 0.22-0.59, P<0.001), PADUA score ( OR=0.37, 95% CI: 0.17-0.81, P=0.013) and Mayo perirenal adhesion index ( OR=0.43, 95% CI: 0.24-0.70, P=0.004) were all independent factors of postoperative MIC comprehensive outcomes in patients with stage T 1b renal cell carcinoma treated with NSS. The C-index of the nomogram model built according to the selected variables was 0.89 with high prediction accuracy; area under the curve (AUC) was 0.84 (95% CI: 0.77-0.91), and it had good predictive performance. Conclusion:Body mass index, lesion morphology, PADUA score and Mayo perirenal adhesion index are independent influencing factors for the MIC comprehensive outcome of patients with stage T 1b renal cell carcinoma after NSS treatment. The nomogram model based on the above indicators has better predictive performance.