Indeterminate Surgical Margins (Rx) in Renal Cell Carcinoma Surgery: Rates, Predictive Factors, and Impact on Overall...

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Research

Background:

• Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery can impact patient survival.
• The clinical significance of Rx versus negative margins (R0) requires further investigation.

Purpose of the Study:

• To determine the rate of Rx in RCC surgery.
• To identify predictors associated with Rx.
• To evaluate the impact of Rx on overall survival compared to R0 resection.

Main Methods:

• Retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020).
• Inclusion of patients who underwent partial or radical nephrectomy.
• Utilized multivariable logistic regression and Cox proportional hazard regression for analysis.

Main Results:

• Rx occurred in 0.62% of cases.
• Partial nephrectomy, laparoscopic approach, and major vein involvement increased Rx odds.
• Rx was associated with significantly worse overall survival (aHR 1.38, P < .01).

Conclusions:

• Rx is not equivalent to R0 resection and is associated with reduced overall survival in RCC patients.
• Findings support improved postoperative risk assessment and clinical decision-making for RCC.
• Highlights the importance of achieving negative margins in RCC surgery.