Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours
Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours
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DOI：
10.1111/j.1464-410x.2006.06623.x
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发表时间：
2007-02-01
影响因子：
4.5
通讯作者：
Russo, Paul
中科院分区：
文献类型：
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作者：
Kwon, Eric O.;Carver, Brett S.;Russo, Paul
目的评价肾皮质肿瘤患者行肾部分切除术（PN）的临床结局，这些患者的手术切缘（SM）阳性，因为最近的研究表明，需要最小的SM才能达到等同的无病生存率（DFS）。在获得机构审查委员会批准后，从我们的前瞻性手术数据库中获得临床和病理学数据。在逻辑回归模型中分析变量，以确定阳性SM的预测因子。局部复发和远处转移的临床结果进行了报告，并使用log-rank test.Results的777个PN，SM状态记录在770; SMs阳性57 770（7%）。423例高恶性潜能肿瘤患者中有33例（8%）出现阳性SM，347例低恶性潜能肿瘤患者中有24例（7%）出现阳性SM。在多变量分析中，PN的强制适应症是阳性SM的重要预测因素（P = 0.003）。存活者的中位随访时间为22个月，57例SM阳性患者中有2例（4%）局部复发，713例SM阴性患者中有4例（0.5%）局部复发。尽管SM阳性，但恶性潜能低的肿瘤患者均未复发。结论：虽然肾皮质肿瘤PN后局部复发很少见，但我们的数据表明，恶性潜能高且SM阳性的肿瘤患者局部复发的发生率可能较高。
OBJECTIVE To evaluate the clinical outcome of patients undergoing partial nephrectomy (PN) for renal cortical tumours who had a positive surgical margin (SM), as recent studies have shown that a minimal SM is required to achieve equivalent disease-free survival (DFS).PATIENTS AND METHODS Between 1989 and 2005, 777 PNs were performed at the authors' institution. Clinical and pathology data were obtained from our prospective surgical database after obtaining institutional review board approval. Variables were analysed in a logistic regression model to determine predictors of positive SMs. The clinical outcome was reported for local recurrence and distant metastasis and analysed using the log-rank test.RESULTS Of the 777 PNs, the SM status was documented in 770; the SMs were positive in 57 of 770 (7%). Positive SMs occurred in 33 of 423 (8%) patients with tumours of high malignant potential, and in 24 of 347 (7%) patients with tumours of low malignant potential. On multivariate analysis, an imperative indication for a PN was a significant predictor for a positive SM (P = 0.003). With a median follow-up for survivors of 22 months, there was a local recurrence in two of 57 (4%) patients with a positive SM and four of 713 (0.5%) with a negative SM. No patients with a tumour of low malignant potential had a recurrence, despite having a positive SM.CONCLUSIONS Although local recurrence after PN for renal cortical tumours is rare, our data suggest that patients with a tumour of high malignant potential and a positive SM might have a higher incidence of local recurrence.