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Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience

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Abstract

Purpose

To evaluate oncologic outcomes and management of patients with microscopic positive surgical margin (PSM) after partial nephrectomy (PN) for renal cell carcinoma (RCC).

Methods

We reviewed our database to identify patients who underwent PN between 1990 and 2015 for RCC and had PSM on final pathology. A 1:3 matching was performed to a negative surgical margin (NSM) cohort. Kaplan–Meier method and log-rank test were used to estimate survival and differences in outcomes, respectively. Cox proportional hazards models were conducted to estimate the Hazards ratio.

Results

A total of 2297 patients underwent PN at our institution, of which 1863 (81%) had RCC. Microscopic PSM was found in 34 (1.8%) RCC patients who were matched to 100 patients with NSM. Of these 34 patients, local recurrence (n = 4), distant kidney recurrences (n = 4), and metastases (n = 5) developed during a median follow-up of 62 months. Bilateral tumors/tumors in a solitary kidney (n = 12/13, 92%), and multifocal tumors (n = 7/13, 54%) were found in patients who developed recurrence/metastasis. PSM patients were at a higher risk of shorter overall survival (p = 0.001), local recurrence-free survival (p = 0.003), distant recurrence-free survival (p = 0.032) and metastasis-free survival (p = 0.018). There was statistically significant association between PSM and bilateral tumors, prior treated RCC at presentation and higher nephrometry score in multivariable model.

Conclusions

There was a low rate of microscopic PSM in our large cohort of patients undergoing PN despite tumor complexity. Higher nephrometry score, bilateral tumors, and prior treated RCC independently predicted PSM which showed worse survival, recurrence and metastasis compared to patients with NSM.

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Authors and Affiliations

  1. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    Firas G. Petros, Michael J. Metcalfe, Kai-Jie Yu, Sarp K. Keskin, Courtney M. Chang, Cindy Gu, Surena F. Matin, Jose A. Karam & Christopher G. Wood

  2. Department of Urology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Kai-Jie Yu

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bryan M. Fellman

  4. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Pheroze Tamboli

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  1. Firas G. Petros
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Contributions

Firas G. Petros, Michael J. Metcalfe, Kai-Jie Yu, Sarp K. Keskin, Bryan M. Fellman, Courtney M. Chang, Cindy Gu: Data analysis. Firas G. Petros, Michael J. Metcalfe: Project development, manuscript writing/editing. Pheroze Tamboli, Surena F. Matin, Jose A. Karam, Christopher G. Wood: Project development, manuscript editing.

Corresponding author

Correspondence to Christopher G. Wood.

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Conflict of interest

All authors have nothing to declare and no competing financial interests in relation to the work described.

Ethical approval

The institutional review board approved this study. For this type of retrospective study formal consent is not required.

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Petros, F.G., Metcalfe, M.J., Yu, KJ. et al. Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience. World J Urol 36, 1093–1101 (2018). https://doi.org/10.1007/s00345-018-2241-7

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  • DOI: https://doi.org/10.1007/s00345-018-2241-7

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