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Recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed by the Kaplan-Meier method and log-rank test. Cox regression was used to identify risk factors associated with RFS, MFS, CSS, and OS. Logistic regression was performed to explore predictors of rupture.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Tumor rupture occurred in 32 of 406 cases (7.9%). With median follow-up of 43 months, 4 (12.5%) and 5 (1.3%) cases experienced recurrence in rupture and non-rupture group, respectively (<jats:italic>P<\/jats:italic> = 0.003). Estimated RFS, MFS, and CSS were shorter in cyst ruptured (CR) group than non-ruptured (nonCR) cases (<jats:italic>P<\/jats:italic> &lt; 0.001; <jats:italic>P<\/jats:italic> = 0.001; <jats:italic>P<\/jats:italic> &lt; 0.001). Cox regression analysis indicated that CR was an independent prognostic factor for RFS (<jats:italic>HR<\/jats:italic> = 7.354; 95% <jats:italic>CI<\/jats:italic> = 1.839\u201329.413; <jats:italic>P<\/jats:italic> = 0.005), MFS (<jats:italic>HR<\/jats:italic> = 8.069; 95% <jats:italic>CI<\/jats:italic> = 1.804\u201336.095; <jats:italic>P<\/jats:italic> = 0.006), and CSS (<jats:italic>HR<\/jats:italic> = 9.643; 95% <jats:italic>CI<\/jats:italic> = 2.183\u201342.599; <jats:italic>P<\/jats:italic> = 0.003). Multivariable logistic regression showed that Bosniak IV was a protective factor for CR (<jats:italic>OR<\/jats:italic> = 0.065; 95% <jats:italic>CI<\/jats:italic> = 0.018\u20130.239; <jats:italic>P<\/jats:italic> &lt; 0.001). However, compared to Bosniak III and I-IIF, Bosniak IV CRMs showed higher rate of clear cell renal cell carcinoma (ccRCC) (76.8% vs 36.5% vs 81.4%) (<jats:italic>P<\/jats:italic> &lt; 0.001) and lower rate of Fuhrman I staging (11.2% vs 66.7% vs 7.4%) (<jats:italic>P<\/jats:italic> &lt; 0.001). Therefore, in ruptured cases, the recurrence rate was higher in CRM with Bosniak IV (50%, 2\/4) than Bosniak I-III (4.4%, 2\/45) (<jats:italic>P<\/jats:italic> = 0.029).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Intraoperative malignant CRM rupture had negative impacts on oncologic outcomes. Bosniak IV was more aggressive than Bosniak I-III and had a higher risk of recurrence after rupture. However, Bosniak IV had a lower risk of rupture, which could weaken even cover-up of the true effect of tumor rupture on oncologic outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12957-022-02824-7","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T21:31:03Z","timestamp":1669411863000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Does intraoperative cyst rupture of malignant cystic renal masses really have no negative impact on oncologic outcomes?"],"prefix":"10.1186","volume":"20","author":[{"given":"Peirong","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bohong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaohui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangting","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyi","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianming","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"issue":"5","key":"2824_CR1","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1097\/MOU.0b013e32833c7b04","volume":"20","author":"BB McGuire","year":"2010","unstructured":"McGuire BB, Fitzpatrick JM. 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