Prevalence and impact on survival of positive surgical margins in partial nephrectomy for renal cell carcinoma: a population-based study
Prevalence and impact on survival of positive surgical margins in partial nephrectomy for renal cell carcinoma: a population-based study
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DOI：
10.1111/j.1464-410x.2012.11675.x
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发表时间：
2013-06-01
影响因子：
4.5
通讯作者：
Abouassaly, Robert
中科院分区：
文献类型：
--
作者：
Ani, Ifeanyi;Finelli, Antonio;Abouassaly, Robert
关于这个主题有什么已知的？以及该研究增加了什么？通过诊断成像对小肾脏肿块 (SRM) 的检测增多，凸显了保留肾功能的重要性，许多患有 SRM 的患者正在接受保留肾单位的手术治疗。手术切缘阳性 (PSM) 的意义是有争议的，各种研究都关注了 PSM 和复发的危险因素。有人认为肿瘤大小可能是一个危险因素，而肿瘤的中心位置被发现是一个增加的危险因素。已发现肿瘤的适应症和位置是复发的独立预测因素。多项研究通过短期到中期随访评估了 PSM 患者的结果。我们的研究的中期中位随访时间为 7.9 年，发现 PSM 和手术切缘阴性的患者之间 5 年疾病特异性生存率和总体生存率没有显着差异。我们还发现肿瘤大小并不显着，但病理分期和脂肪浸润却显着。这些危险因素尚未在之前的研究中发表过。 目的 确定人群水平上手术切缘阳性 (PSM) 的患病率。确定 PSM 的预测因素并评估其对生存的影响。患者和方法 使用安大略省癌症登记处，我们回顾了 1995 年至 2004 年间 664 名肾细胞癌部分肾切除术后患者的病理报告。获得了人口统计信息和病理特征，并进行了多变量逻辑回归分析以确定手术切缘阳性的预测因素。 PSMs.Kaplan-Meier 分析用于按边缘状态检查疾病特异性 (DSS) 和总生存期 (OS)。使用多变量 Cox 比例风险模型来确定 PSM 与生存率之间的独立关联。结果 患者平均年龄为 57.7 岁，其中 61.6% 为男性。肿瘤大小为
What's known on the subject? and What does the study add? The increased detection of small renal masses (SRMs) with diagnostic imaging has highlighted the importance of preserving renal function, with many patients with SRMs being managed with nephron-sparing procedures. The significance of positive surgical margins (PSMs) is debatable and various studies have looked at the risk factors for PSMs and recurrence. It has been suggested that tumour size may be a risk factor and the centrality of the tumour has been found to be an increased risk factor. The indication and location of the tumour has been found to be an independent predictive factor for recurrence. Various studies have assessed the outcome of patients with PSMs with short- to intermediate-term follow-up. Our study has an intermediate-term median follow-up of 7.9 years, and found no significant difference in 5-year disease-specific and overall survival rates between patients with PSMs and negative surgical margins. We also found that tumour size was not significant, but pathological stage and fat invasion were found to be significant. These risk factors have not been published in previous studies.Objectives To determine the prevalence of positive surgical margins (PSMs) on a population level.To identify the predictors of PSMs and assess their impact on survival.Patients and Methods Using the Ontario Cancer Registry, we reviewed pathology reports on 664 patients after partial nephrectomy for renal cell carcinoma between 1995 and 2004.Demographic information and pathological characteristics were obtained and multivariable logistic regression analysis was performed to determine the predictors of PSMs.Kaplan-Meier analysis was used to examine disease-specific (DSS) and overall survival (OS) by margin status. A multivariable Cox proportional hazards model was used to determine the independent association between PSMs and survival.Results The mean patient age was 57.7 years and 61.6% were men. Tumour size was