Evaluation of the Surgical Margin Threshold for Avoiding Recurrence after Partial Nephrectomy in Patients with Renal Cell Carcinoma
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore,we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgicalmargin. Materials and Methods: We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW <1mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-ranktests and multivariate Cox regression models. Results: Of 748 patients (median age, 55 years; interquartile range, 46–64 years; 220 female), 704 (94.2%) and 44 (5.8%) patientshad negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (p<0.001) and wasnot significantly different between SMW ≥1 mm and <1 mm groups (p=0.604). PSM was a significant predictor of recurrence(hazard ratio: 8.03, 95% confidence interval: 2.74–23.56, p<0.001), in contrast to SMW <1 mm (p=0.680). Conclusion: A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgicalmargin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrencein renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.
Abstract
Purpose: An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore,we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgicalmargin. Materials and Methods: We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW <1mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-ranktests and multivariate Cox regression models. Results: Of 748 patients (median age, 55 years; interquartile range, 46–64 years; 220 female), 704 (94.2%) and 44 (5.8%) patientshad negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (p<0.001) and wasnot significantly different between SMW ≥1 mm and <1 mm groups (p=0.604). PSM was a significant predictor of recurrence(hazard ratio: 8.03, 95% confidence interval: 2.74–23.56, p<0.001), in contrast to SMW <1 mm (p=0.680). Conclusion: A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgicalmargin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrencein renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.
참고문헌 (21)
- Dash A, "Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm", BJU Int, 97, pp.939~945 (2006)
- Motzer RJ, "Kidney cancer, version 2. 2017, NCCN clinical practice guidelines in oncology", J Natl Compr Canc Netw, 15, pp.804~834 (2017)
- Campbell S, "Renal mass and localized renal cancer : AUA guideline", J Urol, 198, pp.520~529 (2017)
- Ljungberg B, "EAU guidelines on renal cell carcinoma : 2014 update", Eur Urol, 67, pp.913~924 (2015)
- Leibovich BC, "Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy", J Urol, 171, pp.1066~1070 (2004)
- Zini L, "Radical versus partial nephrectomy : effect on overall and noncancer mortality", Cancer, 115, pp.1465~1471 (2009)
- Lee HJ, "Outcomes of partial nephrectomy for clinical T1b and T2 renal tumors", Curr Opin Urol, 24, pp.448~452 (2014)
- Cao DH, "Simple tumor enucleation may not decrease oncologic outcomes for T1 renal cell carcinoma : a systematic review and meta-analysis", Urol Oncol, 35, pp.661.e15~661.e21 (2017)
- Byrd DR, "AJCC cancer staging handbook" (2010), Springer
- Timsit MO, "Prospective study of safety margins in partial nephrectomy : intraoperative assessment and contribution of frozen section analysis", Urology, 67, pp.923~926 (2006)
- Hung AJ, "“Trifecta” in partial nephrectomy", J Urol, 189, pp.36~42 (2013)
- Piper NY, "Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma?", Urology, 58, pp.849~852 (2001)
- Blackwell RH, "Functional implications of renal tumor enucleation relative to standard partial nephrectomy", Urology, 99, pp.162~168 (2017)
- Chen XS, "Optimal surgical margin in nephron-sparing surgery for T1b renal cell carcinoma", Urology, 79, pp.836~839 (2012)
- Wood EL, "Local tumor bed recurrence following partial nephrectomy in patients with small renal masses", J Urol, 199, pp.393~400 (2018)
- Bensalah K, "Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery", Eur Urol, 57, pp.466~471 (2010)
- Yossepowitch O, "Positive surgical margins at partial nephrectomy : predictors and oncological outcomes", J Urol, 179, pp.2158~2163 (2008)
- Marszalek M, "Positive surgical margins after nephron-sparing surgery", Eur Urol, 61, pp.757~763 (2012)
- Shah PH, "Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors", J Urol, 196, pp.327~334 (2016)
- Schiavina R, "A prospective, multicenter evaluation of predictive factors for positive surgical margins after nephron-sparing surgery for renal cell carcinoma : the RECORd1 Italian project", Clin Genitourin Cancer, 13, pp.165~170 (2015)
- Lee WK, "Characteristics and prognosis of chromophobe non-metastatic renal cell carcinoma : a multicenter study", Int J Urol, 17, pp.898~904 (2010)