Hemorrhage is the most frequent postoperative complication of partial nephrectomy (PN). This study aimed to develop and validate a nomogram to predict hemorrhage after PN in patients with stage T1 renal cell carcinoma (RCC).

Patients diagnosed with stage T1 RCC who underwent PN in our center over a 10-year period were retrospectively reviewed. Hemorrhage was defined as >30 g/L decrease in hemoglobin after surgery, receipt of blood transfusion, presence of arteriovenous fistula or pseudoaneurysm on imaging, or hemorrhage requiring surgical intervention. Univariate and multivariate logistic regression analyses were performed to explore potential risk factors and develop the nomogram. Internal validation was conducted to assess nomogram performance.

Among the 1015 patients included for analysis, 36 experienced hemorrhage (3.55%). Hypertension (odds ratio [OR], 2.657; 95% confidence interval [CI], 1.262–5.594, P = 0.010), tumor size (OR, 10.213; 95% CI, 3.966–26.297; P <0.001), and Mayo Adhesive Probability (MAP) score (OR, 5.158; 95% CI, 2.448–10.868; P <0.001) were independent predictors for hemorrhage and used to construct the nomogram model. The nomogram model showed a favorable predictive efficacy with area under the receiver operator characteristic curve of 0.805 (95% CI, 0.723–0.888). The corrected area under the curve was 0.799 after 1000 bootstrap resampling. The calibration curve showed its stability. Decision curve analysis and the clinical impact curve showed the nomogram’s clinical applicability in a specific threshold range.

We developed a nomogram consisting of hypertension, tumor size, and MAP score as variables to predict hemorrhage after PN in T1 stage RCC that showed high accuracy, discrimination, and stability.