title: Influence of positive surgical margin status after radical nephroureterectomy on upper urinary tract urothelial carcinoma survival.
abstract: BACKGROUND
  The influence of a positive surgical margin (PSM) on survival outcome of post radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC) is unclear. The objectives of this study were to determine the significance of PSM on cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) post RNU.
  
  
  METHODS
  From a multicenter collaborative database, data on SM status, stage, grade, lymph node status, lymphovascular invasion (LVI), tumor location, follow-up, and survival was retrieved for 472 patients. Patients underwent open RNU with bladder cuff excision. Clinicopathological features were compared using χ(2) or Fisher exact test and unpaired t test for categorical and continuous variables, respectively. Survival was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regression models were calculated.
  
  
  RESULTS
  Median follow-up was 27.5 months (12.1-49.3 months). PSM was identified in 44 patients (9.3%) and correlated with pT stage (p = 0.002), grade (p < 0.001), LVI (p < 0.001), and location (p < 0.001). Univariate analyses revealed that PSM was a poor prognostic factor for CSS, RFS, and MFS (p = 0.003, 0.04, and <0.001, respectively). The 5-yr CSS and MFS for PSM was 59.1 and 51.6%, respectively, compared with 83.3 and 79.3% for patients with negative SM. Multivariate analyses revealed that SM status was an independent predictor of MFS [hazard ratio 2.7; p = 0.001).
  
  
  CONCLUSIONS
  PSM after RNU is an important prognostic factor for developing UUT-UC metastases. The status of the surgical margin should be systematically reported on the pathological report and may be a useful variable to include in nomogram risk prediction tools.
authors: Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France. pierre.colin@chru-lille.fr
authors: Pierre
authors: P
authors: Colin
authors: Adil
authors: A
authors: Ouzzane
authors: David R
authors: DR
authors: Yates
authors: François
authors: F
authors: Audenet
authors: Audenet
authors: A
authors: François
authors: Géraldine
authors: G
authors: Pignot
authors: Alexis
authors: A
authors: Arvin-Berod
authors: Olivier
authors: O
authors: Merigot de Treigny
authors: Guy
authors: G
authors: Laurent
authors: Antoine
authors: A
authors: Valeri
authors: Jacques
authors: J
authors: Irani
authors: Irani
authors: I
authors: Jacques
authors: Fabien
authors: F
authors: Saint
authors: Solène
authors: S
authors: Gardic
authors: Pascal
authors: P
authors: Gres
authors: François
authors: F
authors: Rozet
authors: Yann
authors: Y
authors: Neuzillet
authors: Alain
authors: A
authors: Ruffion
authors: Morgan
authors: M
authors: Rouprêt
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium / Q000473:pathology