title: Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors.
abstract: The clinical significance of a positive surgical margin after partial nephrectomy remains controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasms undergoing partial nephrectomy was evaluated.
  
  
  
  A retrospective multi-institutional review of 1,240 patients undergoing partial nephrectomy for clinically localized renal cell carcinoma between 2006 and 2013 was performed. Recurrence-free survival was estimated using the Kaplan-Meier method and evaluated as a function of positive surgical margin with the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (pT2-3a or Fuhrman grades III-IV) and low risk (pT1 and Fuhrman grades I-II) groups.
  
  
  
  A positive surgical margin was encountered in 97 (7.8%) patients. Recurrence developed in 69 (5.6%) patients during a median followup of 33 months, including 37 (10.3%) with high risk disease (eg pT2-pT3a or Fuhrman grade III-IV). A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 2.08, 95% CI 1.09-3.97, p=0.03) but not with site of recurrence. In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases considered high risk (HR 7.48, 95% CI 2.75-20.34, p <0.001) but not low risk (HR 0.62, 95% CI 0.08-4.75, p=0.647).
  
  
  
  Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with adverse pathological features.
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York. Electronic address: pshah1023@gmail.com.
authors.forename: Paras H
authors.initials: PH
authors.lastname: Shah
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.affiliation: Department of Urology, University of California, Irvine, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Vinay R
authors.initials: VR
authors.lastname: Patel
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Department of Urology, University of Chicago, Chicago, Illinois.
authors.forename: Aria A
authors.initials: AA
authors.lastname: Razmaria
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Manaf
authors.initials: M
authors.lastname: Alom
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Oksana
authors.initials: O
authors.lastname: Yaskiv
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schwartz
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California.
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Vira
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: Department of Urology, University of California, Irvine, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.affiliation: Department of Urology, University of Chicago, Chicago, Illinois.
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
authors.affiliation: USC Institute of Urology, University of Southern California, Los Angeles, California.
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
authors.affiliation: Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, New York.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: carcinoma, renal cell; kidney neoplasms; laparoscopy; nephrectomy