A PROSPECTIVE, MULTICENTER EVALUATION OF PREDICTIVE FACTORS FOR POSITIVE SURGICAL MARGINS AFTER NEPHRON SPARING SURGERY FOR RENAL CELL CARCINOMA: THE RECORD1 ITALIAN PROJECT
Altro
Data di Pubblicazione:
2014
Citazione:
A PROSPECTIVE, MULTICENTER EVALUATION OF PREDICTIVE FACTORS FOR POSITIVE SURGICAL MARGINS AFTER NEPHRON SPARING SURGERY FOR RENAL CELL CARCINOMA: THE RECORD1 ITALIAN PROJECT / R. Schiavina, S. Serni, A. Mari, A. Antonelli, R. Bertolo, G. Bianchi, E. Brunocilla, M. Borghesi, M. Carini, N. Longo, G. Martorana, V. Mirone, G. Morgia, F. Porpiglia, B. Rocco, B. Rovereto, C. Simeone, M. Sodano, C. Terrone, V. Ficarra, A. Minervini. ((Intervento presentato al convegno 87° Congresso Nazionale SIU Società Italiana di Urologia tenutosi a Firenze nel 2014.
Abstract:
Aim of the study
Nephron-sparing surgery (NSS) has become the standard of care for the conservative management of
clinically localized renal cell carcinoma (RCC) whenever technically feasible. The excision of the tumor
with a minimal margin of healthy parenchyma surrounding the neoplasm is currently considered the standard
technique for NSS, in order to minimize the risk of positive surgical margins (PSMs) and achieve optimal
local cancer control. We aimed to evaluate the predictors of PSMs after NSS for RCC in one of the largest
available prospective multi-institutional study.
Materials and methods
The Italian Registry of Conservative Renal Surgery (RECORd Project) includes all patients who underwent
conservative surgical treatment for radiologically diagnosed kidney cancers between January 2009
and December 2012 at 19 urological Italian centers. All preoperative anthropometric characteristics,
intraoperative and pathological data were collected. Postoperative complications (within 30 days from
surgery) were recorded. Standard partial nephrectomy (PN) has been defined as the excision of the tumor
comprising a minimal margin of healthy peritumoral renal parenchyma. Simple tumor enucleation (SE) has
been defined as the blunt tumor excision without removing a visible rim of parenchymal tissue around the
pseudocapsule. Multivariable logistic regression models considering factors that were significantly related to
SM status at univariable analysis were applied to analyse predictors of PSM.
Results
Eight hundred consecutive patients were evaluated. 761 (95.1%) and 39 patients (4.9%) achieved negative
and positive surgical margins, respectively. Patients with PSMs were significantly older compared to those
with negative margins (median age: 66.6 vs. 61.8 years, respectively, p=0.001). No statistically significant
differences were found among patients with positive and negative margins in terms of gender, BMI,
indication to NSS (elective/relative vs. imperative), symptoms at the time of diagnosis, ECOG performance
status, number of lesions, clinical stage and tumor side. A higher incidence of PSMs was observed when
NSS was performed for renal masses located in the upper pole (p=0.001). A lower rate of PSM was found
in those patients treated with simple enucleation rather than standard partial nephrectomy (1.6% vs. 7.4%
respectively, p
Discussion
.
Conclusions
The early oncological goal of PN is to achieve negative margins. In our multi-institutional report of open and
minimally invasive NSS, the overall rate of PSM is 4.9%. Young age, SE, middle or lower tumor location
and low grade tumor are all independent predictors of NSMs
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
R. Schiavina, S. Serni, A. Mari, A. Antonelli, R. Bertolo, G. Bianchi, E. Brunocilla, M. Borghesi, M. Carini, N. Longo, G. Martorana, V. Mirone, G. Morgia, F. Porpiglia, B. Rocco, B. Rovereto, C. Simeone, M. Sodano, C. Terrone, V. Ficarra, A. Minervini
Link alla scheda completa: