Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database.

Q1 Medicine

Minerva Urologica E Nefrologica Pub Date : 2020-08-04 DOI:10.23736/S0393-2249.20.03728-5

Stephen T. Ryan, Devin N. Patel, F. Ghali, Sunil H. Patel, R. Sarkar, Kendrick Yim, A. Eldefrawy*, B. Cotta, Aaron W Bradshawh, M. Meagher, Z. Hamilton, James D. Murphy, I. Derweesh

{"title":"Impact of positive surgical margins on survival after partial nephrectomy in localized kidney cancer: analysis of the National Cancer Database.","authors":"Stephen T. Ryan, Devin N. Patel, F. Ghali, Sunil H. Patel, R. Sarkar, Kendrick Yim, A. Eldefrawy*, B. Cotta, Aaron W Bradshawh, M. Meagher, Z. Hamilton, James D. Murphy, I. Derweesh","doi":"10.23736/S0393-2249.20.03728-5","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nThe impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC).\n\n\nMETHODS\nRetrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage [pT1a, pT1b, pT2a, pT2b, and pT3a (upstaged)] and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Subanalysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities.\n\n\nRESULTS\nWe analyzed 42,113 PN [pT1a 33341 (79.2%) pT1a, pT1b 6689 (15.9%), pT2a 757 (1.8%), pT2b 165 (0.4%) and pT3a upstaged 1161 (2.8%)]. PSM occurred in 6.7% (2823) [pT1a 6.5%, pT1b 6.3%, pT2a 5.9%, pT2b 6.1%, pT3a 14.1% p<0.001]. On MVA, PSM was associated with 31% increase in ACM (HR 1.31, p<0.001), which persisted in CCI=0 subanalysis (HR 1.25, p<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, p<0.001), pT2 (86.7% vs. 82.5%, p=0.48), and upstaged pT3a (69% vs. 84.2%, p<0.001).\n\n\nCONCLUSIONS\nPSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in subanalysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.","PeriodicalId":49015,"journal":{"name":"Minerva Urologica E Nefrologica","volume":"15 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"7","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva Urologica E Nefrologica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23736/S0393-2249.20.03728-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 7

Abstract

BACKGROUND The impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. We investigated impact of PSM for patients undergoing PN on overall survival (OS) in different stages of renal cell carcinoma (RCC). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a-cT2b N0M0 RCC between 2004-13. Patients were stratified by pathological stage [pT1a, pT1b, pT2a, pT2b, and pT3a (upstaged)] and analyzed by margin status. Cox Regression multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on all-cause mortality (ACM). Kaplan-Meier analysis (KMA) of OS was performed for PSM versus negative margin (NSM) by pathological stage. Subanalysis of Charlson Comorbidity Index 0 (CCI=0) subgroup was conducted to reduce bias from comorbidities. RESULTS We analyzed 42,113 PN [pT1a 33341 (79.2%) pT1a, pT1b 6689 (15.9%), pT2a 757 (1.8%), pT2b 165 (0.4%) and pT3a upstaged 1161 (2.8%)]. PSM occurred in 6.7% (2823) [pT1a 6.5%, pT1b 6.3%, pT2a 5.9%, pT2b 6.1%, pT3a 14.1% p<0.001]. On MVA, PSM was associated with 31% increase in ACM (HR 1.31, p<0.001), which persisted in CCI=0 subanalysis (HR 1.25, p<0.001). KMA revealed negative impact of PSM vs. NSM on 5-year OS: pT1 (87.3% vs. 90.9%, p<0.001), pT2 (86.7% vs. 82.5%, p=0.48), and upstaged pT3a (69% vs. 84.2%, p<0.001). CONCLUSIONS PSM after PN was independently associated with across-the-board decrement in OS, which worsened in pT3a disease and persisted in subanalysis of patients with CCI=0. PSM should prompt more aggressive surveillance or definitive resection strategies.

查看原文本刊更多论文

阳性切缘对局部肾癌部分切除后生存的影响:国家癌症数据库的分析。

背景:阳性切缘(PSM)对部分肾切除术(PN)预后的影响是有争议的。我们研究了PSM对不同分期肾细胞癌(RCC) PN患者总生存(OS)的影响。方法回顾性分析2004- 2013年间美国国家癌症数据库中因cT1a-cT2b N0M0 RCC接受PN治疗的患者。根据病理分期[pT1a、pT1b、pT2a、pT2b、pT3a(上位)]对患者进行分层，并根据切缘状态进行分析。采用Cox回归多变量分析(MVA)研究PSM和协变量与全因死亡率(ACM)的关系。PSM与阴性切缘(NSM)按病理分期进行OS的Kaplan-Meier分析(KMA)。对Charlson共病指数0 (CCI=0)亚组进行亚分析，以减少共病的偏倚。结果共分析了42,113例PN [pT1a 33341 (79.2%)， pT1a 6689 (15.9%)， pT2a 757 (1.8%)， pT2b 165 (0.4%)， pT3a 1161(2.8%)]。PSM发生率为6.7%(2823例)[pT1a 6.5%， pT1b 6.3%， pT2a 5.9%， pT2b 6.1%， pT3a 14.1% p<0.001]。在MVA中，PSM与ACM增加31%相关(HR 1.31, p<0.001)，在CCI=0亚分析中持续存在(HR 1.25, p<0.001)。KMA显示PSM与NSM对5年OS的负面影响:pT1 (87.3% vs. 90.9%， p<0.001)， pT2 (86.7% vs. 82.5%， p=0.48)和pT3a (69% vs. 84.2%， p<0.001)。结论PN后spsm与OS的全面下降独立相关，在pT3a疾病中恶化，并在CCI=0的患者中持续存在。PSM应提示更积极的监测或明确的切除策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Minerva Urologica E Nefrologica UROLOGY & NEPHROLOGY-

CiteScore

5.50

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The journal Minerva Urologica e Nefrologica publishes scientific papers on nephrology and urology. Manuscripts may be submitted in the form of Minerva opinion editorials, editorial comments, original articles, video illustrated articles, review articles and letters to the Editor.