WCE 2017: Impact of Positive Surgical Margins on Overall Survival after Partial Nephrectomy, a Matched Comparison Based on the National Cancer Database

Vancouver, Canada (UroToday.com) Shum et al. present a retrospective, propensity-matched study of 2,530 patients identified using the National Cancer Database (NCDB). The final analytical cohort included patients who were diagnosed with T1/T2N0M0 renal cell carcinoma and treated with partial nephrectomy between 2004 and 2009. Propensity-matching using variables for age, Charlson Comorbidity Index (CCI), tumor size, histology, and grade was used to create two groups based on the presence or absence of positive surgical margins.  

On Cox multiple regression analysis, a higher risk of all-cause mortality was associated with positive surgical margins (HR 1.39, p = 0.001), older age, CCI equal to or greater than two (HR 2.384, p < 0.001), and tumor size greater than four cm. A lower risk of all-cause mortality was associated with chromophobe histology (HR 0.341, p < 0.001).

These authors are to be commended for addressing the controversial issue of the impact of surgical margins status on survival after partial nephrectomy. However, there are obvious limitations to using the NCDB. The most relevant here is the absence of data on cancer-specific survival and local recurrence rate. 

Presented by: Cheuk Fan Shum

Authors: Cheuk Fan Shum, Clinton D. Bahler, and Chandru P. Sundaram – Indiana University School of Medicine, Indianapolis, IN

Written by: Michael Owyong (@ohyoungmike), LIFT Fellow, Department of Urology, UC Irvine Medical Center, Orange, CA at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.