open access publication

Article, 2024

The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study

Cancers, ISSN 2072-6694, Volume 16, 8, Page 1449, 10.3390/cancers16081449

Contributors

Mosholt, Karina Sif Søndergaard [1] [2] Aagaard, Mark Faurholt [3] Røder, Andreas [1] [2] [4] Azawi, Nessn Htum Majeed 0000-0001-7519-8654 (Corresponding author) [3] [4]

Affiliations

  1. [1] Department of Urology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;, karina.sif.soendergaard.mosholt@regionh.dk, (K.S.S.M.);, andreas.roeder@regionh.dk, (A.R.)
  2. [2] Rigshospitalet
    3. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Zealand University Hospital Roskilde
    4. [NORA names: Region Zealand; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] University of Copenhagen
    5. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD]

Abstract

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.

Keywords

Denmark, NSM, analysis, analysis method, approach, association, carcinoma, cell carcinoma, clinical outcomes, cohort, cohort study, combination, comparative analysis, data, database, department, electronic medical health records, evidence, factors, features, follow-up, health records, high risk, impact, impact of positive surgical margins, improving clinical outcomes, incidence, incidence of positive surgical margins, incomplete resection, kidney tumors, laparoscopic PN, laparoscopy, localized kidney tumors, logistic regression analysis, margin, median follow-up time, medical health records, method, months, multi-center, multi-center study, multicenter cohort, multivariate analysis, multivariate logistic regression analysis, national database, negative impact, negative margins, nephrectomy, outcomes, overall survival, partial nephrectomy, pathological features, patient follow-up, patients, positive surgical margins, predictive factors, prognostic impact, records, recurrence, reduced risk, regression analysis, relationship, renal cell carcinoma, resection, retrospective cohort study, risk, risk factors, risk of positive surgical margins, risk of recurrence, robot-assisted PN, robot-assisted laparoscopy, study, surgical approach, surgical margins, surgical technique, surgically, survival, survival analysis methods, survival outcomes, technique, time, treatment, tumor, univariate, univariate analysis

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