Positive Surgical Margin Appears to Have Negligible Impact on Survival of Renal Cell Carcinomas Treated by Nephron-Sparing Surgery

被引：207

作者：

Bensalah, Karim ^{[1
]}

Pantuck, Allan J. ^{[2
]}

Rioux-Leclercq, Nathalie

Thuret, Rodolphe ^{[3
]}

Montorsi, Francesco ^{[4
]}

Karakiewicz, Pierre I. ^{[5
]}

Mottet, Nicolas ^{[6
]}

Zini, Laurent ^{[7
]}

Bertini, Roberto ^{[4
]}

Salomon, Laurent ^{[8
]}

Villers, Arnaud ^{[7
]}

Soulie, Michel ^{[9
]}

Bellec, Laurent ^{[9
]}

Rischmann, Pascal ^{[9
]}

De La Taille, Alexandre ^{[8
]}

Avakian, Raffi ^{[10
]}

Crepel, Maxime

Ferriere, Jean-Marie ^{[11
]}

Bernhard, Jean-Christophe ^{[11
]}

Dujardin, Thierry ^{[12
]}

Pouliot, Frederic ^{[12
]}

Rigaud, Jerome ^{[13
]}

Pfister, Christian ^{[14
]}

Albouy, Baptiste ^{[14
]}

Guy, Laurent ^{[15
]}

Joniau, Steven ^{[16
]}

van Poppel, Hendrik ^{[16
]}

Lebret, Thierry ^{[17
]}

Culty, Thibault ^{[17
]}

Saint, Fabien ^{[18
]}

Zisman, Amnon ^{[19
]}

Raz, Orit ^{[19
]}

Lang, Herve ^{[20
]}

Spie, Romain ^{[20
]}

Wille, Andreas ^{[21
]}

Roigas, Jan ^{[21
]}

Aguilera, Alfredo ^{[22
]}

Rambeaud, Bastien ^{[6
]}

Martinez Pineiro, Luis ^{[22
]}

Nativ, Ofer ^{[23
]}

Farfara, Roy ^{[23
]}

Richard, Francois ^{[24
]}

Roupret, Morgan ^{[24
]}

Doehn, Christian ^{[25
]}

Bastian, Patrick J. ^{[26
]}

Muller, Stefan C. ^{[26
]}

Tostain, Jacques ^{[6
]}

Belldegrun, Arie S. ^{[2
]}

Patard, Jean-Jacques

机构：

[1] Rennes Univ, Dept Urol, F-35033 Rennes, France

[2] Univ Calif Los Angeles, Los Angeles, CA USA

[3] Univ Montpellier, F-34059 Montpellier, France

[4] Univ Vita Salute San Raffaele, Milan, Italy

[5] Univ Montreal, Montreal, PQ, Canada

[6] Univ St Etienne, St Etienne, France

[7] Univ Lille, Lille, France

[8] Hosp Henri Mondor, Creteil, France

[9] Univ Toulouse, Toulouse, France

[10] Univ Athens, Athens, Greece

[11] Univ Bordeaux, Bordeaux, France

[12] Univ Laval, Quebec City, PQ, Canada

[13] Univ Nantes, Nantes, France

[14] Univ Rouen, Rouen, France

[15] Univ Clermont Ferrand, Clermont Ferrand, France

[16] Katholieke Univ Leuven, Louvain, Belgium

[17] Foch Hosp, Suresne, France

[18] Univ Amiens, Amiens, France

[19] Assaf Harofeh Med Ctr, IL-70300 Zerifin, Israel

[20] Univ Strasbourg, Strasbourg, France

[21] Berlin Char Hosp, Berlin, Germany

[22] La Paz Univ Hosp, Madrid, Spain

[23] Bnai Zion Hosp, Haifa, Israel

[24] Grp Hosp Pitie Salpetriere, F-75634 Paris, France

[25] Lubeck Univ Hosp, Lubeck, Germany

[26] Bonn Univ Hosp, Bonn, Germany

来源：

EUROPEAN UROLOGY | 2010年 / 57卷 / 03期

关键词：

Renal cell carcinoma; Positive margin; Nephron sparing surgery; Survival; LAPAROSCOPIC PARTIAL NEPHRECTOMY; FROZEN-SECTION ANALYSIS; 10-YEAR FOLLOW-UP; ONCOLOGICAL OUTCOMES; TUMOR SIZE; EXPERIENCE; MORBIDITY;

D O I：

10.1016/j.eururo.2009.03.048

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：466 / 471

页数：6

共 17 条

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