Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High-Risk Renal Tumors

OBJECTIVE - The clinical significance of positive surgical margin after partial nephrectomy remains controversial. Association between positive margin and risk of disease recurrence among patients with clinically localized renal neoplasms undergoing partial nephrectomy was evaluated.

METHODS - A retrospective multi-institutional review of 1240 patients undergoing partial nephrectomy for clinically localized renal cell carcinoma between 2006 and 2013 was performed. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of positive surgical margin with log-rank test and Cox models adjusting for tumor size, grade, histology, pathologic stage, focality, and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathologic high-risk (pT2-3a or Fuhrman grades III-IV) and low-risk (pT1 and Fuhrman grades I-II) groups.

RESULTS - Positive surgical margin was encountered in 97 (7.8%) patients. Recurrence developed in 69 (5.6%) patients over a median follow up of 33 months, including 37 (10.3%) patients with high-risk disease (e.g. pT2-pT3a or Fuhrman grade III-IV). Positive margin was associated with increased risk of relapse on multivariable analysis (HR=2.08, 95% CI=1.09-3.97, P=0.03), but not with site of recurrence. In a stratified analysis based on pathological features, positive surgical margin was significantly associated with a higher risk of recurrence among patients considered high-risk (HR=7.48, 95% CI=2.75-20.34, P<0.001) but not low-risk (HR=0.62, 95% CI=0.08-4.75, P=0.647).

CONCLUSIONS - Positive surgical margin after partial nephrectomy increases risk of disease recurrence, primarily in patients with adverse pathologic features.

The Journal of urology. 2016 Feb 18 [Epub ahead of print]

Paras H Shah, Daniel M Moreira, Zhamshid Okhunov, Vinay R Patel, Sameer Chopra, Aria A Razmaria, Manaf Alom, Arvin K George, Oksana Yaskiv, Michael J Schwartz, Mihir Desai, Manish A Vira, Lee Richstone, Jaime Landman, Arieh L Shalhav, Inderbir Gill, Louis R Kavoussi

Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY. Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, University of California, Irvine, CA., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., USC Institute of Urology, University of Southern California, Los Angeles, CA., Department of Urology, University of Chicago, Chicago, IL., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., USC Institute of Urology, University of Southern California, Los Angeles, CA., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY., Department of Urology, University of California, Irvine, CA., Department of Urology, University of Chicago, Chicago, IL., USC Institute of Urology, University of Southern California, Los Angeles, CA., Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY.