Positive surgical margin following radical nephrectomy is an independent predictor of local recurrence and disease-specific survival

World Journal of Surgical Oncology

Research

Raya Leibowitz-Amit¹  Raanan Berger¹  Edi Fridman²  Yasmin Abu-Ghanem³  Jacob Ramon³  Issac Kaver³  Zohar A. Dotan³ 

[1] Department of Oncology, Sheba Medical Center, Ramat Gan, Israel;Department of Pathology, Sheba Medical Center, Ramat Gan, Israel;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Department of Urology, Sheba Medical Center, Ramat Gan, Israel;

关键词: Positive surgical margins;    Radical nephrectomy;    Renal cell carcinoma;    Recurrence, progression and overall mortality;    Disease-specific mortality;   

DOI  :  10.1186/s12957-017-1257-6

 received in 2017-09-02, accepted in 2017-10-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPositive surgical margins (PSM) are recognized as an adverse prognostic sign and are often associated with higher rates of local and systemic disease recurrence. The data regarding the oncological outcome for PSM following radical nephrectomy (RN) is limited. We examined the predictive factors for PSM and its influence on survival and site of recurrence in patients treated with RN for renal cell carcinoma (RCC).MethodsClinical, pathologic and follow-up data on 714 patients undergoing RN for kidney cancer were analyzed. Secondary analysis included 44 patients with metastatic RCC upon diagnosis who underwent cytoreductive nephrectomy (CRN). Univariate and multivariable logistic regression models were fit to determine clinicopathologic features associated with PSM. A Cox proportional-hazards regression model was used to test the independent effects of clinical and pathologic variables on survival.ResultsPSM was documented in 17 cases (2.4%). PSM were associated with tumour size, advanced pathologic stage (pT3 vs. ≤ pT2) and presence of necrosis. On multivariate analysis, cancer-specific survival (CSS) was associated with tumour stage, size, presence of necrosis and PSM. PSM was also associated with local recurrence but not distant metastasis or overall survival (OS). CSS and OS were comparable between the PSM and metastatic RCC groups, but significantly lower than the negative margin group.ConclusionsThe prevalence of PSM following RN is rare. Pathological data, including advanced stage (> pT2), tumour necrosis and tumour size, are associated with the presence of PSM. PSM is associated with tumour recurrence and CSS. Patients with PSM are a potential group for adjuvant therapy or for more careful and thorough follow-up following surgery.

【 授权许可】

CC BY   
© The Author(s). 2017