Impact of Positive Surgical Margins on Recurrence and Overall Survival Following Partial Nephrectomy: A Systematic Review and Meta-Analysis.

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

Urology Journal Pub Date : 2025-01-12 DOI:10.22037/uj.v21i.8459

MohmmadAmin Omrani, Abbas Basiri, Mehran Rahimlou

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引用次数: 0

Abstract

Purpose: Positive surgical margins (PSM) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are a concern due to potential implications for recurrence and survival. This systematic review and meta-analysis assess the impact of PSM on recurrence rates and progression-free survival in RCC patients.

Methods: We conducted a systematic search of PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception through July 2024. Studies examining recurrence and survival outcomes in RCC patients with and without PSM post-PN were included. A random-effects model was applied to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) for recurrence and survival.

Results: Thirty studies met the inclusion criteria. Our analysis showed that PSM was significantly associated with a higher risk of local recurrence (HR = 2.13, 95% CI: 1.67-2.72) and a lower recurrence/progression-free survival (HR = 1.70, 95% CI: 1.40-2.07) compared to negative surgical margins. Subgroup analyses indicated consistent results across study designs and RCC histologic subtypes.

Conclusion: The presence of PSM following PN for RCC is associated with a 2.13-fold increase in local recurrence and a 1.7-fold reduction in progression-free survival, emphasizing the need for precise margin management during surgery. These findings highlight the importance of optimizing surgical techniques and considering adjuvant treatment strategies for patients with PSM to improve oncologic outcomes.

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阳性切缘对部分肾切除术后复发和总生存率的影响：系统回顾和荟萃分析。

目的：肾细胞癌（RCC）部分肾切除术（PN）后的阳性切缘（PSM）是一个值得关注的问题，因为它可能影响复发和生存。本系统综述和荟萃分析评估了PSM对RCC患者复发率和无进展生存期的影响。方法：我们对PubMed、Embase、Scopus、Cochrane和Web of Science数据库进行了系统检索，检索时间从成立到2024年7月。研究纳入了有和没有PSM的肾细胞癌患者pn后的复发和生存结果。采用随机效应模型计算复发和生存的合并风险比（HR）和95%置信区间（CI）。结果：30项研究符合纳入标准。我们的分析显示，与阴性手术切缘相比，PSM与较高的局部复发风险（HR = 2.13, 95% CI: 1.67-2.72）和较低的复发/无进展生存期（HR = 1.70, 95% CI: 1.40-2.07）显著相关。亚组分析表明，研究设计和RCC组织学亚型的结果一致。结论：肾癌PN后PSM的存在与局部复发率增加2.13倍和无进展生存期减少1.7倍相关，强调手术中需要精确的切缘管理。这些发现强调了优化手术技术和考虑辅助治疗策略对PSM患者改善肿瘤预后的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urology Journal UROLOGY & NEPHROLOGY-

CiteScore

2.60

自引率

6.70%

发文量

审稿时长

6-12 weeks

期刊介绍： As the official journal of the Urology and Nephrology Research Center (UNRC) and the Iranian Urological Association (IUA), Urology Journal is a comprehensive digest of useful information on modern urology. Emphasis is on practical information that reflects the latest diagnostic and treatment techniques. Our objectives are to provide an exceptional source of current and clinically relevant research in the discipline of urology, to reflect the scientific work and progress of our colleagues, and to present the articles in a logical, timely, and concise format that meets the diverse needs of today’s urologist. Urology Journal publishes manuscripts on urology and kidney transplantation, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. Accordingly, original articles, case reports, and letters to editor are encouraged.