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.
Written by:
Schiavina R, Serni S, Mari A, Antonelli A, Bertolo R, Bianchi G, Brunocilla E, Borghesi M, Carini M, Longo N, Martorana G, Mirone V, Morgia G, Porpiglia F, Rocco B, Rovereto B, Simeone C, Sodano M, Terrone C, Ficarra V, Minervini A. Are you the author?
Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy; Clinica Urologica I, AOUC, Università di Firenze, Italy; Unità Operativa di Urologia Dipartimento di Nefro Urologia; Azienda AO Spedali Civili di Brescia, Italy; Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy; Policlinico di Modena, Clinica Urologica, Università di Modena, Italy; Policlinico Federico II, Università di Napoli, Italia; Luna Foundation, Italy; UOC urologia Ospedale maggiore ca' granda policlinico mangiagalli regina Elena Università degli studi di Milano, Milan, Italy; I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Pavia, Italy; Dipartimento di Urologia, Azienda Ospedaliera Maggiore della Carità, Novara, Italy; Clinica Urologica, Università di Padova, Padova, Italy.
Reference: Clin Genitourin Cancer. 2015 Apr;13(2):165-70.
doi: 10.1016/j.clgc.2014.08.008
PubMed Abstract
PMID: 25450033