Evaluating the Role of Age in Post-Nephrectomy Outcomes for Patients with Early-Stage Renal Cell Carcinoma: A Retrospective Multi-Centre Cohort Study

Background & Objectives: Renal cell carcinoma (RCC) incidence is rising among both elderly and younger populations. This study aimed to investigate the impact of age on long-term oncological outcomes following curative nephrectomy for early-stage RCC. Methods A retrospective analysis was conducted using data from 5 Chinese medical centers, including patients who underwent curative nephrectomy for T1-T2 RCC between 2008 and 2023. Patients aged < 40 years and ≥ 75 years were compared for overall survival (OS), cancer-specific survival (CSS), and recurrence rates. Propensity score matching (PSM) was employed to balance baseline characteristics. Results Of 357 patients, 234 (65.5%) were young and 123 (34.5%) were elderly. PSM yielded 96 pairs. In the matched cohort, young patients demonstrated significantly lower 5-year OS (76.0% vs 86.5%, P  = 0.038) and CSS rates (86.5% vs 93.8%, P  = 0.019) compared to elderly patients. The 5-year cumulative recurrence rate was higher in young patients (28.1% vs 13.5%, P  = 0.003). Multivariable analysis confirmed young age as an independent risk factor for decreased OS (HR 2.407, 95% CI 1.387–4.177; P  = 0.002) and increased recurrence (HR 2.824, 95% CI 1.393–5.722; P  = 0.004). Conclusion Diverging from traditional expectations, our study reveals that younger patients experienced poorer long-term outcomes after curative nephrectomy for early-stage RCC. These findings suggest the need for more intensive surveillance and possibly more aggressive treatment strategies for young RCC patients.