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Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery.

Karim Bensalah 1 Allan Pantuck 2 Nathalie Rioux-Leclercq 1 Rodolphe Thuret 3 Francesco Montorsi 4 Pierre Karakiewicz 5, 6 Nicolas Mottet 7, 8 Laurent Zini 9 Roberto Bertini 4 Laurent Salomon 10 Arnaud Villers 9 Michel Soulie 11 Laurent Bellec 11 Pascal Rischmann 11 Alexandre de la Taille 12 Raffi Avakian 13 Maxime Crépel 1 Jean-Marie Ferriere 14 Jean-Christophe Bernhard 14 Thierry Dujardin 15 Frédéric Pouliot 15 Jérôme Rigaud 16 Christian Pfister 17 Baptiste Albouy 17 Laurent Guy 18 Steven Joniau 19 Hendrik van Poppel 19 Thierry Lebret 20 Thibault Culty 20 Fabien Saint 21 Amnon Zisman 22 Orit Raz 22 Hervé Lang 23 Romain Spie 23 Andreas Wille 24 Jan Roigas 24 Alfredo Aguilera 25 Bastien Rambeaud 8 Luis Martinez Piñeiro 25 Ofer Nativ 26 Roy Farfara 26 François Richard 27 Morgan Roupret 27 Christian Doehn 28 Patrick Bastian 29 Stefan Muller 29 Jacques Tostain 7, 8 Arie Belldegrun 2 Jean-Jacques Patard 1, 30
Abstract : BACKGROUND: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history. OBJECTIVE: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN. DESIGN, SETTING, AND PARTICIPANTS: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade. MEASUREMENTS: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. RESULTS AND LIMITATIONS: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival. CONCLUSIONS: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.
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Submitted on : Tuesday, April 14, 2009 - 12:47:04 PM
Last modification on : Wednesday, August 19, 2020 - 11:17:01 AM



Karim Bensalah, Allan Pantuck, Nathalie Rioux-Leclercq, Rodolphe Thuret, Francesco Montorsi, et al.. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery.. European Urology, Elsevier, 2010, 57 (3), pp.466-71. ⟨10.1016/j.eururo.2009.03.048⟩. ⟨inserm-00375254⟩



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