Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery.
Karim Bensalah
(1)
,
Allan J. Pantuck
(2)
,
Nathalie Rioux-Leclercq
(1)
,
Rodolphe Thuret
(3)
,
Francesco Montorsi
(4)
,
Pierre I. Karakiewicz
(5, 6)
,
Nicolas Mottet
(7, 8)
,
Laurent Zini
(9)
,
Roberto Bertini
(4)
,
Laurent J. 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 J. Bastian
(29)
,
Stefan C. Muller
(29)
,
Jacques Tostain
(7, 8)
,
Arie S. Belldegrun
(2)
,
Jean-Jacques Patard
(1, 30)
1
Service d'urologie [Rennes] = Urology [Rennes]
2 Department of Urology
3 Service Urologie [Lapeyronie]
4 Department of urology
5 Cancer Prognostics and Health Outcomes Unit
6 Cancer Prognostics and Health Outcome Unit
7 Service d'Urologie - Andrologie [CHU Saint-Etienne]
8 UJM - Université Jean Monnet - Saint-Étienne
9 Service d'urologie
10 Service d'urologie [Mondor]
11 Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse]
12 IMRB - Institut Mondor de Recherche Biomédicale
13 NKUA - National and Kapodistrian University of Athens
14 Service d'urologie, andrologie et transplantation rénale
15 UT - Université de Toulouse
16 UN - Université de Nantes
17 Service d'urologie [Rouen]
18 ISIT - Image Science for Interventional Techniques
19 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
20 Service d'urologie
21 UPJV - Université de Picardie Jules Verne
22 Assaf Harofeh Medical Centre
23 Service d'urologie
24 Berlin Charity Hospital
25 La Paz University Hospital
26 Bnai Zion Hospital
27 CHU Pitié-Salpêtrière [AP-HP]
28 Lubeck University Hospital
29 University Hospital Bonn
30 IGDR - Institut de Génétique et Développement de Rennes
2 Department of Urology
3 Service Urologie [Lapeyronie]
4 Department of urology
5 Cancer Prognostics and Health Outcomes Unit
6 Cancer Prognostics and Health Outcome Unit
7 Service d'Urologie - Andrologie [CHU Saint-Etienne]
8 UJM - Université Jean Monnet - Saint-Étienne
9 Service d'urologie
10 Service d'urologie [Mondor]
11 Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse]
12 IMRB - Institut Mondor de Recherche Biomédicale
13 NKUA - National and Kapodistrian University of Athens
14 Service d'urologie, andrologie et transplantation rénale
15 UT - Université de Toulouse
16 UN - Université de Nantes
17 Service d'urologie [Rouen]
18 ISIT - Image Science for Interventional Techniques
19 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
20 Service d'urologie
21 UPJV - Université de Picardie Jules Verne
22 Assaf Harofeh Medical Centre
23 Service d'urologie
24 Berlin Charity Hospital
25 La Paz University Hospital
26 Bnai Zion Hospital
27 CHU Pitié-Salpêtrière [AP-HP]
28 Lubeck University Hospital
29 University Hospital Bonn
30 IGDR - Institut de Génétique et Développement de Rennes
Maxime Crépel
- Fonction : Auteur
- PersonId : 754983
- IdHAL : maxime-crepel
- ORCID : 0000-0001-9032-6538
- IdRef : 156972417
Fabien Saint
- Fonction : Auteur
- PersonId : 1154894
- ORCID : 0000-0002-4410-9572
- IdRef : 07432389X
François Richard
- Fonction : Auteur
- PersonId : 758044
- ORCID : 0000-0003-4353-3619
Résumé
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.