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Multicenter Study
. 2016 Aug;196(2):327-34.
doi: 10.1016/j.juro.2016.02.075. Epub 2016 Feb 19.

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

Paras H Shah  1 , Daniel M Moreira  2 , Zhamshid Okhunov  3 , Vinay R Patel  4 , Sameer Chopra  5 , Aria A Razmaria  6 , Manaf Alom  4 , Arvin K George  7 , Oksana Yaskiv  4 , Michael J Schwartz  4 , Mihir Desai  5 , Manish A Vira  4 , Lee Richstone  4 , Jaime Landman  3 , Arieh L Shalhav  6 , Inderbir Gill  5 , Louis R Kavoussi  4
Affiliations
Multicenter Study

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

Paras H Shah et al. J Urol. 2016 Aug.

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.

Keywords: carcinoma, renal cell; kidney neoplasms; laparoscopy; nephrectomy.

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Figures

Figure 1.
Figure 1.
RFS by margin status
Figure 2.
Figure 2.
Association of PSM with recurrence by subgroups
Figure 3.
Figure 3.
RFS by margin status and risk group. Low risk (LR)—pT1 and Fuhrman grade I-II. High risk (HR)—pT2-3 or Fuhrman grade III-IV.
See this image and copyright information in PMC

Comment in

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