Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative

Rahul K. Bansal, Simon Tanguay, Antonio Finelli, Ricardo Rendon, Ronald B. Moore, Rodney H. Breau, Louis Lacombe, Peter C. Black, Jun Kawakami, Darrel Drachenberg, Stephen Pautler, Olli Saarela, Zhihui Liu, Michael A.S. Jewett, Anil Kapoor

Abstract


Introduction: We sought to determine the incidence, risk factors, and prognosis for patients with positive surgical margin (PSM) during partial nephrectomy (PN) for renal cell carcinoma (RCC).

Methods: From the Canadian Kidney Cancer information system (CKCis) database, a historical cohort of PN patients with PSM were identified and compared to negative surgical margin (NSM). Risk factors for PSM were examined through multivariable logistic regression. Kaplan-Meier curves were used to compare progression- free survival.

Results: Of 1103 patients, 972 (88.1%), 71 (6.4%), and 60 (5.4%) had NSM, PSM, and unknown status, respectively. Median patient age and tumour size were 61 years and 3.0 cm for both groups. From multivariable analysis, pathological stage ≥T3 (odds ratio [OR] 2.51; 95% confidence interval [CI] 1.13–5.60) and Fuhrman grade 4 (OR 5.35; 95% CI 1.11‒25.72) were associated with PSM, whereas age, operative technique, and tumour size were not. Forty-nine (5.0%) patients from the NSM cohort and seven (9.9%) from the PSM cohort had a local/systemic progression of disease (adjusted hazard ratio [HR] 1.4; 95% CI 0.6‒3.6). There were three (0.3%) cancer-related deaths in the NSM group and none in the PSM group. After median followup of 19 (interquartile range [IQR] 5‒42) and 15 (IQR 7–30) months, 855 (91.4%) and 61 (89.7%) patients were alive in the NSM and PSM groups, respectively.

Conclusions: PSM occurred in 6.4% of PNs performed for RCC in this pan-Canadian cohort. Higher stage and grade are associated with a higher risk of positive margin. The small association between a PSM and progression suggests that complete nephrectomy is not necessary in patients with a PSM. The main study limitations are lack of nephrometry score and possible reporting bias.


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DOI: http://dx.doi.org/10.5489/cuaj.4264