title: A prospective, multicenter evaluation of predictive factors for positive surgical margins after nephron-sparing surgery for renal cell carcinoma: the RECORd1 Italian Project.
abstract: BACKGROUND
  The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies.
  
  
  METHODS
  We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs.
  
  
  RESULTS
  Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P = .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P = .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P = .01), upper pole tumor location (OR, 2.85; P = .005), standard PN (OR, 3.45; P = .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P = .001) were found to be independent predictors of PSMs.
  
  
  CONCLUSIONS
  In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy. Electronic address: rschiavina@yahoo.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.affiliation: Unità Operativa di Urologia Dipartimento di Nefro Urologia; Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Policlinico di Modena, Clinica Urologica, Università di Modena, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Policlinico Federico II, Università di Napoli, Italia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.affiliation: Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Policlinico Federico II, Università di Napoli, Italia.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Luna Foundation, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.affiliation: Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: UOC urologia Ospedale maggiore ca' granda policlinico mangiagalli regina Elena Università degli studi di Milano, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.affiliation: I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Pavia, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rovereto
authors.affiliation: Unità Operativa di Urologia Dipartimento di Nefro Urologia; Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Unità Operativa di Urologia Dipartimento di Nefro Urologia; Azienda AO Spedali Civili di Brescia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sodano
authors.affiliation: Dipartimento di Urologia, Azienda Ospedaliera Maggiore della Carità, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Clinica Urologica, Università di Padova, Padova, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Clinica Urologica I, AOUC, Università di Firenze, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009399:Nephrons / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Partial nephrectomy; Positive margin; Predictors; Renal cancer; Simple tumor enucleation