Abstract：
BACKGROUND: The implications of positive surgical margins (PSM) after surgery for renal cell carcinoma (RCC) remain subject of discussion. This study aimed to identify risk factors for PSM, assess its effect on overall survival (OS), and determine predictors of OS.
METHODS: Data from RCC surgeries at Mannheim University Medical Center between 2010 and 2023 was analyzed. Propensity score matching balanced PSM and control groups using age, surgical approach, tumor stage, histological subtype, and American Association of Anesthesiologists (ASA) score. Logistic and cox regression models predict PSM and OS, respectively. Kaplan-Meier analysis compared OS of PSM patients and controls.
RESULTS: A total of 1066 RCC patients were included. Propensity score matching yielded 32 PSM patients and 96 controls. Multivariable logistic regression identified tumor stage ≥ T3a (odds ratio [OR] = 2.74, 95% confidence interval [CI] = 1.0-6.8, P = .04) and chromophobe, compared to clear cell, RCC (OR = 3.19, 95% CI = 1.0-8.7, P = .03) as independent predictors of PSM. Multivariable cox regression found age > 65 years (hazard ratio [HR] = 2.65, 95% CI = 1.7-4.2, P < .01) and tumor stage ≥ T3a (HR = 2.25, 95% CI = 1.4-3.7, P < .01) to predict shorter OS. Partial vs. radical nephrectomy was associated with improved OS (HR = 0.49, 95% CI = 0.3-0.9, P = .02). Kaplan-Meier analysis revealed no OS difference between PSM patients and controls (P = .49) over a 45-month median follow-up.
CONCLUSIONS: PSM is not a primary determinant of inferior survival, while age and tumor stage play a more prominent role. A well-calibrated follow-up protocol for PSM patients, combining PSM with coinciding factors such as tumor stage, grade, size, or PSM extent, is crucial for adequate surveillance while preventing excessive interventions.
METHODS: Data from RCC surgeries at Mannheim University Medical Center between 2010 and 2023 was analyzed. Propensity score matching balanced PSM and control groups using age, surgical approach, tumor stage, histological subtype, and American Association of Anesthesiologists (ASA) score. Logistic and cox regression models predict PSM and OS, respectively. Kaplan-Meier analysis compared OS of PSM patients and controls.
RESULTS: A total of 1066 RCC patients were included. Propensity score matching yielded 32 PSM patients and 96 controls. Multivariable logistic regression identified tumor stage ≥ T3a (odds ratio [OR] = 2.74, 95% confidence interval [CI] = 1.0-6.8, P = .04) and chromophobe, compared to clear cell, RCC (OR = 3.19, 95% CI = 1.0-8.7, P = .03) as independent predictors of PSM. Multivariable cox regression found age > 65 years (hazard ratio [HR] = 2.65, 95% CI = 1.7-4.2, P < .01) and tumor stage ≥ T3a (HR = 2.25, 95% CI = 1.4-3.7, P < .01) to predict shorter OS. Partial vs. radical nephrectomy was associated with improved OS (HR = 0.49, 95% CI = 0.3-0.9, P = .02). Kaplan-Meier analysis revealed no OS difference between PSM patients and controls (P = .49) over a 45-month median follow-up.
CONCLUSIONS: PSM is not a primary determinant of inferior survival, while age and tumor stage play a more prominent role. A well-calibrated follow-up protocol for PSM patients, combining PSM with coinciding factors such as tumor stage, grade, size, or PSM extent, is crucial for adequate surveillance while preventing excessive interventions.
摘要：
背景：肾细胞癌（RCC）手术后手术切缘阳性（PSM）的影响仍是讨论的主题。本研究旨在确定PSM的风险因素，评估其对总生存期（OS）的影响，并确定操作系统的预测因素。
方法：分析了2010年至2023年在曼海姆大学医学中心进行RCC手术的数据。使用年龄匹配平衡PSM和对照组的倾向评分，手术方法,肿瘤分期,组织学亚型，和美国麻醉医师协会（ASA）评分。Logistic和cox回归模型预测PSM和OS，分别。Kaplan-Meier分析比较了PSM患者和对照组的OS。
结果：共纳入1066例RCC患者。倾向评分匹配产生了32名PSM患者和96名对照。多变量逻辑回归确定肿瘤分期≥T3a（比值比[OR]=2.74，95％置信区间[CI]=1.0-6.8，P=.04）和发色，与透明细胞相比，RCC（OR=3.19，95%CI=1.0-8.7，P=0.03）是PSM的独立预测因子。多变量cox回归发现年龄>65岁（风险比[HR]=2.65，95％CI=1.7-4.2，P<0.01）和肿瘤分期≥T3a（HR=2.25，95％CI=1.4-3.7，P<0.01）来预测较短的OS。部分vs.根治性肾切除术与OS改善相关(HR=0.49,95%CI=0.3-0.9,P=.02)。Kaplan-Meier分析显示，在45个月的中位随访中，PSM患者和对照组之间没有OS差异（P=0.49）。
结论：PSM不是生存率低下的主要决定因素，而年龄和肿瘤分期则起着更突出的作用。针对PSM患者的校准良好的随访方案，将PSM与肿瘤分期等重合因素相结合，grade,尺寸,或PSM范围，对于充分的监测至关重要，同时防止过度干预。
方法：分析了2010年至2023年在曼海姆大学医学中心进行RCC手术的数据。使用年龄匹配平衡PSM和对照组的倾向评分，手术方法,肿瘤分期,组织学亚型，和美国麻醉医师协会（ASA）评分。Logistic和cox回归模型预测PSM和OS，分别。Kaplan-Meier分析比较了PSM患者和对照组的OS。
结果：共纳入1066例RCC患者。倾向评分匹配产生了32名PSM患者和96名对照。多变量逻辑回归确定肿瘤分期≥T3a（比值比[OR]=2.74，95％置信区间[CI]=1.0-6.8，P=.04）和发色，与透明细胞相比，RCC（OR=3.19，95%CI=1.0-8.7，P=0.03）是PSM的独立预测因子。多变量cox回归发现年龄>65岁（风险比[HR]=2.65，95％CI=1.7-4.2，P<0.01）和肿瘤分期≥T3a（HR=2.25，95％CI=1.4-3.7，P<0.01）来预测较短的OS。部分vs.根治性肾切除术与OS改善相关(HR=0.49,95%CI=0.3-0.9,P=.02)。Kaplan-Meier分析显示，在45个月的中位随访中，PSM患者和对照组之间没有OS差异（P=0.49）。
结论：PSM不是生存率低下的主要决定因素，而年龄和肿瘤分期则起着更突出的作用。针对PSM患者的校准良好的随访方案，将PSM与肿瘤分期等重合因素相结合，grade,尺寸,或PSM范围，对于充分的监测至关重要，同时防止过度干预。
