TY - JOUR
T1 - A prospective, multicenter evaluation of predictive factors for positive surgical margins after nephron-sparing surgery for renal cell carcinoma
T2 - The record1 italian project
AU - Schiavina, Riccardo
AU - Serni, Sergio
AU - Mari, Andrea
AU - Antonelli, Alessandro
AU - Bertolo, Riccardo
AU - Bianchi, Giampaolo
AU - Brunocilla, Eugenio
AU - Borghesi, Marco
AU - Carini, Marco
AU - Longo, Nicola
AU - Martorana, Giuseppe
AU - Mirone, Vincenzo
AU - Morgia, Giuseppe
AU - Porpiglia, Francesco
AU - Rocco, Bernardo
AU - Rovereto, Bruno
AU - Simeone, Claudio
AU - Sodano, Mario
AU - Terrone, Carlo
AU - Ficarra, Vincenzo
AU - Minervini, Andrea
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P =.001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P =.001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P <.0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P <.0001). At multivariable analysis, age (odds ratio [OR], 1.04; P =.01), upper pole tumor location (OR, 2.85; P =.005), standard PN (OR, 3.45; P =.004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P =.001) were found to be independent predictors of PSMs. Conclusion In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.
AB - Background The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. Patients and Methods We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. Results Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P =.001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P =.001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P <.0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P <.0001). At multivariable analysis, age (odds ratio [OR], 1.04; P =.01), upper pole tumor location (OR, 2.85; P =.005), standard PN (OR, 3.45; P =.004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P =.001) were found to be independent predictors of PSMs. Conclusion In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.
KW - Partial nephrectomy
KW - Positive margin
KW - Predictors
KW - Renal cancer
KW - Simple tumor enucleation
UR - http://www.scopus.com/inward/record.url?scp=84924369262&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2014.08.008
DO - 10.1016/j.clgc.2014.08.008
M3 - Article
SN - 1558-7673
VL - 13
SP - 165
EP - 170
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
IS - 2
ER -