Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors

医学 肾切除术 手术切缘 病态的 肾细胞癌 比例危险模型 对数秩检验 回顾性队列研究 阶段(地层学) 危险系数 外科 T级 内科学 低风险 泌尿科 置信区间 癌症 总体生存率 古生物学 生物
作者
Paras Shah,Daniel M. Moreira,Zhamshid Okhunov,Vinay Patel,Sameer Chopra,Aria Razmaria,Manaf Alom,Arvin K. George,Oksana Yaskiv,Michael J. Schwartz,Mihir Desai,Manish Vira,Lee Richstone,Jaime Landman,Arieh L. Shalhav,Inderbir S. Gill,Louis R. Kavoussi
出处
期刊:The Journal of Urology [Lippincott Williams & Wilkins]
卷期号:196 (2): 327-334 被引量:151
标识
DOI:10.1016/j.juro.2016.02.075
摘要

No AccessJournal of UrologyAdult Urology1 Aug 2016Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors Paras H. Shah, Daniel M. Moreira, Zhamshid Okhunov, Vinay R. Patel, Sameer Chopra, Aria A. Razmaria, Manaf Alom, Arvin K. George, Oksana Yaskiv, Michael J. Schwartz, Mihir Desai, Manish A. Vira, Lee Richstone, Jaime Landman, Arieh L. Shalhav, Inderbir Gill, and Louis R. Kavoussi Paras H. ShahParas H. Shah Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Daniel M. MoreiraDaniel M. Moreira Department of Urology, Mayo Clinic, Rochester, Minnesota , Zhamshid OkhunovZhamshid Okhunov Department of Urology, University of California, Irvine, California , Vinay R. PatelVinay R. Patel Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Sameer ChopraSameer Chopra USC Institute of Urology, University of Southern California, Los Angeles, California , Aria A. RazmariaAria A. Razmaria Department of Urology, University of Chicago, Chicago, Illinois , Manaf AlomManaf Alom Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Arvin K. GeorgeArvin K. George Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland , Oksana YaskivOksana Yaskiv Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Michael J. SchwartzMichael J. Schwartz Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Mihir DesaiMihir Desai USC Institute of Urology, University of Southern California, Los Angeles, California , Manish A. ViraManish A. Vira Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Lee RichstoneLee Richstone Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York , Jaime LandmanJaime Landman Department of Urology, University of California, Irvine, California , Arieh L. ShalhavArieh L. Shalhav Department of Urology, University of Chicago, Chicago, Illinois , Inderbir GillInderbir Gill USC Institute of Urology, University of Southern California, Los Angeles, California , and Louis R. KavoussiLouis R. Kavoussi Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.075AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The clinical significance of a positive surgical margin after partial nephrectomy remains controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasms undergoing partial nephrectomy was evaluated. Materials and Methods: A retrospective multi-institutional review of 1,240 patients undergoing partial nephrectomy for clinically localized renal cell carcinoma between 2006 and 2013 was performed. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of positive surgical margin with the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (pT2-3a or Fuhrman grades III-IV) and low risk (pT1 and Fuhrman grades I-II) groups. Results: A positive surgical margin was encountered in 97 (7.8%) patients. Recurrence developed in 69 (5.6%) patients during a median followup of 33 months, including 37 (10.3%) with high risk disease (eg pT2-pT3a or Fuhrman grade III-IV). A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 2.08, 95% CI 1.09–3.97, p=0.03) but not with site of recurrence. In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases considered high risk (HR 7.48, 95% CI 2.75–20.34, p <0.001) but not low risk (HR 0.62, 95% CI 0.08–4.75, p=0.647). Conclusions: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with adverse pathological features. References 1 : Guideline for management of the clinical T1 renal mass. J Urol2009; 182: 1271. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCadeddu J (2019) Re: Surgical Approach Does Not Impact Margin Status after Partial Nephrectomy for Large Renal MassesJournal of Urology, VOL. 202, NO. 2, (192-193), Online publication date: 1-Aug-2019.Laguna M (2018) Re: Oncologic Outcomes of Patients with Positive Surgical Margin after Partial Nephrectomy: A 25-Year Single Institution ExperienceJournal of Urology, VOL. 201, NO. 1, (27-28), Online publication date: 1-Jan-2019.Campbell S, Uzzo R, Allaf M, Bass E, Cadeddu J, Chang A, Clark P, Davis B, Derweesh I, Giambarresi L, Gervais D, Hu S, Lane B, Leibovich B and Pierorazio P (2017) Renal Mass and Localized Renal Cancer: AUA GuidelineJournal of Urology, VOL. 198, NO. 3, (520-529), Online publication date: 1-Sep-2017.Mouracade P, Kara O, Maurice M, Dagenais J, Malkoc E, Nelson R and Kaouk J (2016) Patterns and Predictors of Recurrence after Partial Nephrectomy for Kidney TumorsJournal of Urology, VOL. 197, NO. 6, (1403-1409), Online publication date: 1-Jun-2017.Cotter K and Dahm P (2016) Re: The Prognostic Impact of a Positive Vascular Margin on pT3 Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 196, NO. 4, (1317-1318), Online publication date: 1-Oct-2016.Kim S and Abouassaly R (2016) Treatment of Patients with Positive Margins after Partial NephrectomyJournal of Urology, VOL. 196, NO. 2, (301-302), Online publication date: 1-Aug-2016.Smith J (2016) This Month in Adult UrologyJournal of Urology, VOL. 196, NO. 2, (295-296), Online publication date: 1-Aug-2016. Volume 196Issue 2August 2016Page: 327-334 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordslaparoscopycarcinoma, renal cellnephrectomykidney neoplasmsMetricsAuthor Information Paras H. Shah Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Daniel M. Moreira Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Zhamshid Okhunov Department of Urology, University of California, Irvine, California More articles by this author Vinay R. Patel Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Sameer Chopra USC Institute of Urology, University of Southern California, Los Angeles, California More articles by this author Aria A. Razmaria Department of Urology, University of Chicago, Chicago, Illinois More articles by this author Manaf Alom Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Arvin K. George Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author Oksana Yaskiv Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Michael J. Schwartz Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Mihir Desai USC Institute of Urology, University of Southern California, Los Angeles, California More articles by this author Manish A. Vira Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Lee Richstone Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Jaime Landman Department of Urology, University of California, Irvine, California More articles by this author Arieh L. Shalhav Department of Urology, University of Chicago, Chicago, Illinois More articles by this author Inderbir Gill USC Institute of Urology, University of Southern California, Los Angeles, California More articles by this author Louis R. Kavoussi Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York More articles by this author Expand All Advertisement PDF downloadLoading ...
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