1. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery
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Romain Spie, Jérôme Rigaud, Jacques Tostain, Michel Soulié, Bastien Rambeaud, Hendrik Van Poppel, Alfredo Aguilera, Maxime Crepel, Laurent Zini, Ofer Nativ, Jean Marie Ferriere, Luis Martinez Pineiro, Steven Joniau, Patrick J. Bastian, Rodolphe Thuret, Jean Jacques Patard, Stefan C. Müller, Frédéric Pouliot, Jean-Christophe Bernhard, Amnon Zisman, Andreas H. Wille, Christian Pfister, Pascal Rischmann, Nicolas Mottet, Laurent Bellec, Alexandre de la Taille, Allan J. Pantuck, Laurent Guy, Thierry Dujardin, R. Avakian, Jan Roigas, François Richard, Nathalie Rioux-Leclercq, Christian Doehn, Pierre I. Karakiewicz, Arie S. Belldegrun, Roberto Bertini, Orit E. Raz, Karim Bensalah, Laurent Salomon, B. Albouy, T. Culty, Thierry Lebret, Morgan Rouprêt, A. Villers, Francesco Montorsi, Fabien Saint, Herve Lang, Roy Farfara, Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Department of Urology, University of California [Los Angeles] (UCLA), University of California-University of California, Service Urologie [Lapeyronie], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Department of urology, Università Vita-Salute San Raffaele, Cancer Prognostics and Health Outcomes Unit, Université de Montréal (UdeM), Cancer Prognostics and Health Outcome Unit, Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Université Jean Monnet [Saint-Étienne] (UJM), Service d'urologie, Hôpital Huriez-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'urologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), National and Kapodistrian University of Athens (NKUA), Service d'urologie, andrologie et transplantation rénale, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Fédérale Toulouse Midi-Pyrénées, Université de Nantes (UN), Service d'urologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Hôpital Foch [Suresnes], Université de Picardie Jules Verne (UPJV), Assaf Harofeh Medical Centre, Tel Aviv University [Tel Aviv]-Assaf Harofeh Medical Centre, CHU Strasbourg, Berlin Charity Hospital, La Paz University Hospital, Bnai Zion Hospital, Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Lubeck University Hospital, Bonn University Hospital, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), University of California (UC)-University of California (UC), CHU Saint-Etienne-Université Jean Monnet - Saint-Étienne (UJM)-Hôpital nord, Université Jean Monnet - Saint-Étienne (UJM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Tel Aviv University (TAU)-Assaf Harofeh Medical Centre, Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS), De Villemeur, Hervé, Bensalah, Karim, Pantuck Allan, J., Rioux Leclercq, Nathalie, Thuret, Rodolphe, Montorsi, Francesco, Karakiewicz Pierre, I., Mottet, Nicola, Zini, Laurent, Bertini, Roberto, Salomon, Laurent, Villers, Arnaud, Soulie, Michel, Bellec, Laurent, Rischmann, Pascal, De La Taille, Alexandre, Avakian, Raffi, Crepel, Maxime, Ferriere Jean, Marie, Bernhard Jean, Christophe, Dujardin, Thierry, Pouliot, Frederic, Rigaud, Jerome, Pfister, Christian, Albouy, Baptiste, Guy, Laurent, Joniau, Steven, van Poppel, Hendrik, Lebret, Thierry, Culty, Thibault, Saint, Fabien, Zisman, Amnon, Raz, Orit, Lang, Herve, Spie, Romain, Wille, Andrea, Roigas, Jan, Aguilera, Alfredo, Rambeaud, Bastien, Martinez Pineiro, Lui, Nativ, Ofer, Farfara, Roy, Richard, Francoi, Roupret, Morgan, Doehn, Christian, Bastian Patrick, J., Muller Stefan, C., Tostain, Jacque, Belldegrun Arie, S., Patard Jean, Jacques, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and University Hospital Bonn
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Surgical margin ,medicine.medical_specialty ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,MESH: Survival Rate ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,Nephrectomy ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,03 medical and health sciences ,0302 clinical medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Renal cell carcinoma ,Predictive Value of Tests ,medicine ,Humans ,Survival rate ,Carcinoma, Renal Cell ,MESH: Nephrons ,Retrospective Studies ,MESH: Humans ,MESH: Middle Aged ,Proportional hazards model ,business.industry ,Retrospective cohort study ,MESH: Retrospective Studies ,Nephrons ,MESH: Carcinoma, Renal Cell ,Middle Aged ,medicine.disease ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Kidney Neoplasms ,MESH: Predictive Value of Tests ,3. Good health ,Surgery ,Survival Rate ,MESH: Nephrectomy ,030220 oncology & carcinogenesis ,Predictive value of tests ,MESH: Kidney Neoplasms ,business ,Kidney cancer - Abstract
International audience; BACKGROUND: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history. OBJECTIVE: To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN. DESIGN, SETTING, AND PARTICIPANTS: Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade. MEASUREMENTS: PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. RESULTS AND LIMITATIONS: Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival. CONCLUSIONS: PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.
- Published
- 2010
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