Does Margin Length Predict Recurrence After Partial Nephrectomy, or Is Presence Alone Sufficient?
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Keywords
length of margin, partial nephrectomy, recurrence
Abstract
To evaluate whether the length of positive surgical margin carries a risk for recurrence, data of patients that underwent partial nephrectomy (PN) from six centers were evaluated. Fifty-three patints with positive surgical margins (PSMs) (the PSM group) and 438 patients with negative surgical margin (the NSM group) were included in the present study. Pathologic reevaluations were performed, and surgical margins were measured in micrometers. The number of positive margin areas, and the length of the maximum and total positive margins were evaluated. Data were analyzed using SPSS 27 package program. A p-value less than 0.001 was considered statistically significant. Local recurrence occured in 16.98% of patients in the PSM group and 4.24% of patients in the NSM group. (p<0.001). Patients with PSM were at fourfold increased risk for recurrence. Age, gender, tumor location, tumor side and size, and fuhrman grade were not associated with local recurrence of the tumor (p>0.01). However, positive surgical margin was an important risk factor for local recurrence (p<0.01). No relationship was found between pos-itive margin length and local recurrence (p=0.044). Logistic regression analysis did not identify any parameters associated with local recurrence. The presence of a PSM was significantly associated with an increased risk of local recurrence following PN. The number of positive margin foci and total or maximum length of margin involvement were not associated with recurrence. These findings suggest that it is the presence of PSM, rather than its extent, that may be the primary factor influencing oncological risk.
References
2. Volpe A, Capitanio U, Falsaperla M, Giannarini G, Palumbo C, Antonelli A, et al. Nephrectomy for renal tumors: recommendations of the Italian Society of Urology RCC working group. Minerva Urology and Nephrology. 2024 Feb;76(1):9–21.
https://doi.org/10.23736/S2724-6051.24.05772-0
3. Wood EL, Adibi M, Qiao W, Brandt J, Zhang M, Tamboli P, et al. Local tumor bed recurrence following partial nephrectomy in patients with small renal masses. Journal of Urology. 2018 Feb;199(2):393–400. https://doi.org/10.1016/j.juro.2017.09.072
4. Capitanio U, Terrone C, Antonelli A, Minervini A, Volpe A, Furlan M, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. European Urology. 2015 Apr;67(4):683–9. https://doi.org/10.1016/j.eururo.2014.09.027
5. Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. European Urology. 2014 Feb;65(2):372–7. https://doi.org/10.1016/j.eururo.2013.06.044
6. Lee Z, Jegede OA, Haas NB, Pins MR, Messing EM, Manola J, et al. Local recurrence following resection of intermediate-high risk nonmetastatic renal cell carcinoma: an anatomical classification and analysis of the ASSURE (ECOG-ACRIN E2805) adjuvant trial. Journal of Urology. 2020 Apr;203(4):684–689. https://doi.org/10.1097/JU.0000000000000588
7. Chin AI, Lam JS, Figlin RA, Belldegrun AS. Surveillance strategies for renal cell carcinoma patients following nephrectomy. Reviews in Urology. 2006 Winter;8(1):1–7.
8. Matos AC, Dall'Oglio MF, Colombo JR, Crippa A, Juveniz JAQ, Argolo FC. Predicting outcomes in partial nephrectomy: is the renal score useful? International Brazilian Journal of Urology. 2017 May–Jun;43(3):422–431. https://doi.org/10.1590/s1677-5538.ibju.2016.0315
9. Minervini A, Campi R, Lane BR, Cobelli OD, Sanguedolce F, Hatzichristodoulou G, et al. Impact of resection technique on perioperative outcomes and surgical margins after partial nephrectomy for localized renal masses: a prospective multicenter study. Journal of Urology. 2020 Mar;203(3):496–504. https://doi.org/10.1097/JU.0000000000000591
10. Minervini A, Campi R, Sessa F, Derweesh I, Kaouk JH, Mari A, et al. Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: systematic review of the literature and meta-analysis of prevalence. Minerva Urologica e Nefrologica. 2017 Dec;69(6):523–538. https://doi.org/10.23736/S0393-2249.17.02864-8
11. Bertolo R, Pecoraro A, Carbonara U, Amparore D, Diana P, Muselaers S, et al. Resection techniques during robotic partial nephrectomy: a systematic review. European Urology Open Science. 2023 Apr 29:52:7–21. https://doi.org/10.1016/j.euros.2023.03.008
12. Sun M, Shariat SH, Cheng C, Ficarra V, Murai M, Oudard S, et al. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. European Urology. 2011 Oct;60(4):644–61. https://doi.org/10.1016/j.eururo.2011.06.041
13. van den Brink L, Reijerink MAA, Henderickx M M E L, Bex A, Jamaludin FS, Beerlage HP, et al. Is frequent imaging necessary? Impact of computed tomography during follow-up after surgical treatment for nonmetastatic renal cell carcinoma: a systematic review. European Urology Oncology. 2025 Jun;8(3):829–840. https://doi.org/10.1016/j.euo.2024.11.014
14. Leibovich MC, Blute ML, Cheville JC, Lohse CM, Frank I, Kwon ED, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003 Apr 1;97(7):1663–71. https://doi.org/10.1002/cncr.11234
15. Tabourin T, Pinar U, Parra J, Vaessen C, Bensalah CK, Audenet F, et al. Impact of renal cell carcinoma histological variants on recurrence after partial nephrectomy: a multi-institutional, prospective study (UROCCR Study 82). Annals of Surgical Oncology. 2022 Oct;29(11):7218–7228. https://doi.org/10.1245/s10434-022-12052-8
16. Demirel HC, Çakmak S, Yavuzsan AH, Yeşildal C, Türk S, Dalkılınç A, et al. Prognostic factors for surgical margin status and recurrence in partial nephrectomy. International Journal of Clinical Practice. 2020 Oct;74(10):e13587.
https://doi.org/10.1111/ijcp.13587
17. Shah PH, Moreira DM, Patel VR, Gaunay G, George AK, Alom M, et al. Partial nephrectomy is associated with higher risk of relapse compared with radical nephrectomy for clinical stage T1 renal cell carcinoma pathologically up staged to T3a. 2017 Aug;198(2):289–296. https://doi.org/10.1016/j.juro.2017.03.012
18. Takagi T, Yoshida K, Wada A, Kondo T, Fukuda, Ishihara H, et al. Predictive factors for recurrence after partial nephrectomy for clinical T1 renal cell carcinoma: a retrospective study of 1227 cases from a single institution. International Journal of Clinical Oncology. 2020 May;25(5):892–898. https://doi.org/10.1007/s10147-020-01632-x
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