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Influence of Positive Surgical Margin Status After Radical Nephroureterectomy on Upper Urinary Tract Urothelial Carcinoma Survival

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 19 November 2012

Abstract

Background

The influence of a positive surgical margin (PSM) on survival outcome of post radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC) is unclear. The objectives of this study were to determine the significance of PSM on cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) post RNU.

Methods

From a multicenter collaborative database, data on SM status, stage, grade, lymph node status, lymphovascular invasion (LVI), tumor location, follow-up, and survival was retrieved for 472 patients. Patients underwent open RNU with bladder cuff excision. Clinicopathological features were compared using χ2 or Fisher exact test and unpaired t test for categorical and continuous variables, respectively. Survival was estimated using the Kaplan–Meier method, and univariate and multivariate Cox proportional hazards regression models were calculated.

Results

Median follow-up was 27.5 months (12.1–49.3 months). PSM was identified in 44 patients (9.3 %) and correlated with pT stage (p = 0.002), grade (p < 0.001), LVI (p < 0.001), and location (p < 0.001). Univariate analyses revealed that PSM was a poor prognostic factor for CSS, RFS, and MFS (p = 0.003, 0.04, and <0.001, respectively). The 5-yr CSS and MFS for PSM was 59.1 and 51.6 %, respectively, compared with 83.3 and 79.3 % for patients with negative SM. Multivariate analyses revealed that SM status was an independent predictor of MFS [hazard ratio 2.7; p = 0.001).

Conclusions

PSM after RNU is an important prognostic factor for developing UUT-UC metastases. The status of the surgical margin should be systematically reported on the pathological report and may be a useful variable to include in nomogram risk prediction tools.

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Acknowledgment

The authors would like to kindly thank other collaborators from the French collaborative national database on UUT-UC: Emilie Adam, Baptiste Albouy, Medhi-Mokhtar Ariane, Frédéric Arroua, Marie Audouin, Marie Dominique Azemar, Henri Bensadoun, Pierre Bigot, Franck Bruyère, Luc Cormier, Jean-Nicolas Cornu, Sébastien Crouzet, Olivier Cussenot, Francky Delage, Alexandre De la Taille, Aurélien Descazeaud, Stéphane Droupy, Emmanuel Ravier, Pascal Gres, Julien Guillotreau, Nicolas Hoareau, Alain Houlgatte, Sophie Hurel, Gilles Karsenty, Jean Alexandre Long, Charlotte Maurin, Véronique Phé, Thomas Polguer, Mathieu Roumiguié, Frédéric Staerman, Michel Soulié, and Evanguelos Xylinas.

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Authors and Affiliations

  1. Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France

    Pierre Colin MD & Adil Ouzzane MD

  2. Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France

    David R. Yates MD, Audenet François MD & Morgan Rouprêt MD, PhD

  3. Academic Department of Urology, Cochin Hospital, Assistance Publique–Hôpitaux de Paris, René Descartes University, Paris, France

    Géraldine Pignot MD

  4. Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble, France

    Alexis Arvin-Berod MD

  5. Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France

    Olivier Merigot de Treigny MD

  6. Academic Department of Urology, CHRU Clermont-Ferrand, University of Clermont-Ferrand, Clermont-Ferrand, France

    Guy Laurent MD

  7. Academic Department of Urology, CHRU Brest, University of Brest, Brest, France

    Antoine Valeri MD, PhD

  8. Academic Department of Urology, CHRU Poitiers, University of Poitiers, Poitiers, France

    Irani Jacques MD, PhD

  9. Academic Department of Urology, CHRU Amiens, University of Amiens, Amiens, France

    Fabien Saint MD, PhD

  10. Academic Department of Urology, CHRU Limoges, University of Limoges, Limoges, France

    Solène Gardic MD

  11. Academic Department of Urology, CHRU Nîmes, University of Nîmes, Nîmes, France

    Pascal Gres MD

  12. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    François Rozet MD

  13. Academic Department of Urology, Academic Hospital of Foch, Suresnes, France

    Yann Neuzillet MD

  14. Academic Department of Urology, CHRU Lyon Sud, University of Lyon, Lyon, France

    Alain Ruffion MD, PhD

  15. Hôpital Claude Huriez, Lille, France

    Pierre Colin MD

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  1. Pierre Colin MD
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  2. Adil Ouzzane MD
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  11. Fabien Saint MD, PhD
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  16. Alain Ruffion MD, PhD
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  17. Morgan Rouprêt MD, PhD
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Corresponding author

Correspondence to Pierre Colin MD.

Additional information

This study was conducted on behalf of the French Collaborative National Database on UUT-UC.

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Colin, P., Ouzzane, A., Yates, D.R. et al. Influence of Positive Surgical Margin Status After Radical Nephroureterectomy on Upper Urinary Tract Urothelial Carcinoma Survival. Ann Surg Oncol 19, 3613–3620 (2012). https://doi.org/10.1245/s10434-012-2453-9

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  • DOI: https://doi.org/10.1245/s10434-012-2453-9

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