Cardiovascular disease-specific mortality after partial versus radical nephrectomy for stage II renal cancer: A SEER-based propensity-matched analysis

Background Surgery remains standard treatment for localized renal cancer. Whether partial nephrectomy (PN), compared with radical nephrectomy (RN), affects long-term cardiovascular disease-specific mortality (CVD-SM) in stage II disease is uncertain. We assessed this association using competing-risk methods. Methods Patients with T2N0M0 renal cancer diagnosed in the SEER database from 2004 to 2022 were included. Missing tumor grade and unspecified T2 subclassification were addressed by multiple imputation. Propensity-score matching was performed within 10 imputed datasets. Cumulative incidence functions were estimated using the Aalen–Johansen method. Fine–Gray models were primary, with cause-specific Cox models as supportive analyses; estimates were pooled across imputations. Results The cohort included 14,602 patients (PN, n = 1294; RN, n = 13,308), with a median follow-up of 85 months. After matching, 1290–1292 patients per group were retained. Five-year CVD-SM cumulative incidence was 2.68% after PN and 3.07% after RN; 10-year estimates were 7.18% and 6.63%, respectively. No significant association was observed (Fine–Gray sHR, 1.10; 95% CI, 0.69–1.74; P = 0.690; Cox HR, 1.04; 95% CI, 0.66–1.64; P = 0.867). PN was associated with lower cancer-specific mortality (Fine–Gray sHR, 0.58; 95% CI, 0.42–0.80; P < 0.001). Conclusion Among patients with stage II renal cancer, surgical approach was not significantly associated with CVD-SM. However, estimate imprecision and unavailable cardiovascular and renal risk factors preclude claims of equivalence or exclusion of clinically meaningful effects. The potential cardiovascular benefit of PN remains uncertain. Its lower cancer-specific mortality should be interpreted cautiously because residual surgical-selection confounding may persist. Synopsis Cardiovascular disease-specific mortality represents an important long-term competing risk in patients with stage II renal cancer. No statistically significant association between surgical approach and cardiovascular disease-specific mortality was detected, leaving the cardiovascular survival advantage of partial nephrectomy uncertain.