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Surgical Margin Status and Outcomes After Radical Nephrectomy

By: Joshua Swore
Posted: Thursday, February 4, 2021

Positive surgical margins after radical nephrectomy in patients with T3 stage renal cell carcinomas resulted in shorter relapse-free survival, according to an article published in the Journal of Surgical Oncology. “Such findings open the way for the possibility of future use of these factors as predictors of attaining negative surgical margins and hence relapse-free survival,” commented Mike G. Martin, MD, of West Cancer Center Research & Institute, and colleagues at the University of Tennessee.

A total of 485 patients with renal cell carcinoma who underwent radical nephrectomy were the study's focus. Most patients had T1 or T2 disease and had negative surgical margins (n = 443). The others had T4 disease and positive surgical margins (n = 42). Those patients with T3 disease had a more equal distribution between negative (n = 48) and positive margins (n = 29).

The authors showed that patients with T3 renal cell carcinomas had a significant difference in tumor laterality. Patients achieved negative margins having left-sided tumors and patients with positive margins having right-sided tumors.

During a median follow-up of 24.8 months, the group also reported 22 patients with T3 carcinomas experienced disease progression. The progression-free survival at 1 year was 72% for those with positive surgical margins, whereas those with negative surgical margins had a 1-year progression-free survival of 87.5%. In addition, a significant difference in progression-free survival occurred at 3- and 4-year follow-ups. At 3 years, progression-free survival rates were 62.1% for those with positive surgical margins versus 83.3% for those with negative surgical margins (hazard ratio [HR] = 4.3, 95% confidence interval [CI] = 1.3–13.6, P = .01). Furthermore, the 5-year progression-free survival rates were 58.6% versus 79.2% (HR = 4.3, 95% CI = 1.4–13.2, P = .01), respectively.

Disclosure: The study authors reported no conflicts of interest.



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