Background:Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark.Methods:This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann–Whitney Test, independent Student’st-test, or Pearson’s chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods.Results:A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p= 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins.Conclusions:Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.
背景：对于小型局限性肾肿瘤，部分肾切除术（PN）是首选治疗方法。PN术后可能出现切除不完全导致手术切缘阳性（PSM）的情况。PSM对复发风险及生存结局的影响尚未完全明确。本研究旨在通过丹麦大型多中心队列，探讨PN术后PSM与复发风险及生存影响之间的关系。 方法：本回顾性队列研究纳入2010年至2016年间在丹麦三家医疗中心因肾细胞癌（RCC）接受PN治疗的患者。通过电子医疗健康记录和国家数据库获取病理特征、手术技术及患者随访数据。综合运用描述性统计、比较分析（采用Mann-Whitney检验、独立样本t检验或Pearson卡方检验）、单因素与多因素逻辑回归分析及生存分析方法。 结果：共纳入523例患者，其中48例（9.1%）出现PSM。55例患者（10.5%）观察到复发，中位随访时间为75个月。研究发现机器人辅助PN的PSM发生率显著低于开放或腹腔镜PN（p=0.01）。单因素分析显示PSM与较高复发风险相关，但多因素分析未证实此关联。然而本研究统计效能不足，未能充分描述PSM与其他风险因素间的相互作用。PSM患者与切缘阴性患者的总生存期无显著差异。 结论：本研究进一步证实了PSM对RCC患者PN术后复发的负面影响，强调实现阴性手术切缘对改善临床结局的重要性。手术方式被证实是影响PSM风险的唯一预测因素，其中机器人辅助腹腔镜手术可降低PSM风险。
肿瘤(癌症)患者之家