PD07-08 IMPACT OF POSITIVE SURGICAL MARGINS ON SURVIVAL AFTER PARTIAL NEPHRECTOMY IN LOCALIZED KIDNEY CANCER: ANALYSIS OF THE NATIONAL CANCER DATABASE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2018PD07-08 IMPACT OF POSITIVE SURGICAL MARGINS ON SURVIVAL AFTER PARTIAL NEPHRECTOMY IN LOCALIZED KIDNEY CANCER: ANALYSIS OF THE NATIONAL CANCER DATABASE Stephen Ryan, Reith Sarkar, Ahmet Bindayi, Zachary Hamilton, James Murphy, and Ithaar Derweesh Stephen RyanStephen Ryan More articles by this author , Reith SarkarReith Sarkar More articles by this author , Ahmet BindayiAhmet Bindayi More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , James MurphyJames Murphy More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.441AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Impact of positive surgical margins (PSM) on outcomes in partial nephrectomy (PN) is controversial. PN utilization has increased across clinical stage categories, with a concordant increase in PSM rate. We sought to understand impact of PSM for patients undergoing PN on overall survival (OS). METHODS Retrospective analysis of patients from the US National Cancer Database who underwent partial nephrectomy (PN) for clinically localized (cT1a-cT2b N0M0) renal cell carcinoma between 2003-13. Patients were stratified into their pathological stage [pT1a, pT1b, pT2a, pT2b, and pT3a (upstaged)] and analyzed by final margin status. Cox Regression Multivariable analysis (MVA) was performed to investigate associations of PSM and covariates on OS. Kaplan-Meier analysis (KMA) of OS was performed for PSM verses negative margin (NSM) for overall cohort and by stage. RESULTS We analyzed 33,276 PN events [26085 (78.3%) pT1a, 5364 (16.1%) pT1b, 685 (2.1%) pT2a, 153 (0.5%) pT2b, and 989 (3%) with pT3a upstaging]. Upstaging occurred in 3.0% overall (2.1% cT1a, 5.6% cT1b, 10.9% cT2a, 10.0% cT2b, p<0.001). Overall PSM rate was 6.7% (6.5% pT1a, 6.1% pT1b, 5.8% pT2a 5.8% pT2b, 13.8% pT3a upstaged). On MVA for all cause mortality, PSM was independently predictive for decreased OS (HR 1.36, p<0.001), in addition to increasing age (HR 1.05, p<0.001), non Caucasian race (HR 4.6-11.7, p=0.017 to <0.001), increasing charlson score (HR 7, p<0.001), non-private insurance (p<0.001), and increasing pathologic T stage (HR 1.5-2.1, p<0.001). KMA revealed worsened 5-year OS for PSM vs. NSM overall (90.5% vs. 85.9%, p<0.001) and for pT1a (91.9% vs. 87.4%, p=0.004), pT1b (85.7% vs. 81.7%, p=0.044), pT2b (79% vs. 65%, p=0.01), and upstaged pT3a (82% vs. 74%, p=0.005). CONCLUSIONS PSM was associated with an across the board and stage-specific decrement in OS, particularly in pathologically upstaged patients undergoing PN. While the mechanism of decreased OS cannot be elucidated due to limitations in the NCBD, these data nonetheless suggest that PSM in PN is associated with increased oncological risk and should prompt more aggressive surveillance or definitive resection strategies, in particular in patients with tumors of higher oncologic risk. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e159 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Stephen Ryan More articles by this author Reith Sarkar More articles by this author Ahmet Bindayi More articles by this author Zachary Hamilton More articles by this author James Murphy More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...