Predicting positive surgical margins in partial nephrectomy: A prospective multicentre observational study (the RECORd 2 project).

Aged Area Under Curve Carcinoma, Renal Cell / secondary Databases, Factual Elective Surgical Procedures / statistics & numerical data Female Hospitals, High-Volume / statistics & numerical data Hospitals, Low-Volume / statistics & numerical data Humans Kidney Neoplasms / pathology Logistic Models Male Margins of Excision Middle Aged Neoplasm Invasiveness Neoplasm Staging Neoplasm, Residual Nephrectomy / methods Nomograms Prospective Studies ROC Curve Risk Factors

Nephron-sparing surgery Nomogram Partial nephrectomy Renal cell carcinoma Robot-assisted partial nephrectomy Surgical margins

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

ISSN: 1532-2157

Titre abrégé: Eur J Surg Oncol

Pays: England

ID NLM: 8504356

Informations de publication

Date de publication:
07 2020

Historique:

received: 11 12 2019

accepted: 15 01 2020

pubmed: 3 2 2020

medline: 30 12 2020

entrez: 3 2 2020

Statut: ppublish

Résumé

to evaluate clinical predictors of positive surgical margins (PSMs) in a large multicenter prospective observational study and to develop a clinic nomogram to predict the likelihood of PSMs after partial nephrectomy (PN). We prospectively evaluated 4308 patients who had surgical treatment for renal tumors between January 2013 and December 2016 at 26 urological Italian Centers (RECORd 2 project). Two multivariable logistic models were evaluated to predict the likelihood of PSMs. Center caseload was dichotomized using a visual assessment adjusted for several predictors of PSMs. A nomogram predicting PSMs was developed. Overall, 2076 patients treated with PN were evaluated. pT1a, pT1b, pT2 and pT3a were recorded in 68.7%, 22.6%, 2.1% and 6.6% of the patients, respectively. PSMs were recorded in 342 (16.5%) patients. From a null multivariable model against number of PN/year, 60 PN/year were identified as the best cut-off to define a high-volume centre. At multivariable analysis, clinical stage (cT1a vs. cT2 [OR 1.94]; p = 0.03), volume centre (≤60 PN/year) (OR 2.22; p < 0.0001), imperative vs elective indication (OR 2.10; p = 0.04), surgical technique (laparoscopic vs. open [OR 1.62; p = 0.002), lymphovascular invasion (OR 2.27; p = 0.01) and upstaging to pT3a (OR 2.81; p < 0.0001) were independent predictors of PSMs. The final nomogram included age, ASA score, Charlson score, clinical tumor stage, surgical indication, surgical approach, surgical technique, PADUA score, clamp procedure and volume centre. PSMs after PN were significantly more likely in patients with lower clinical stage, higher PADUA score, in individuals referred to laparoscopic PN and in those treated at lower volume centers. We used these data to develop a nomogram to predict such risk.

Identifiants

DOI: 10.1016/j.ejso.2020.01.022 PMID: 32007380

pubmed: 32007380

pii: S0748-7983(20)30041-X

doi: 10.1016/j.ejso.2020.01.022

pii:

doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

1353-1359

Investigateurs

Vincenzo Altieri (V)

Francesco Berardinelli (F)

Marco Borghesi (M)

Carlo Andrea Bravi (CA)

Pierluigi Bove (P)

Giovanni Enrico Cacciamani (GE)

Riccardo Campi (R)

Antonio Celia (A)

Elisabetta Costantini (E)

Luigi Da Pozzo (L)

Mario Falsaperla (M)

Matteo Ferro (M)

Maria Furlan (M)

Simone Sforza (S)

Francesco Marson (F)

Francesco Montorsi (F)

Sebastiano Nazzani (S)

Angelo Porreca (A)

Giorgio Ivan Russo (GI)

Luigi Schips (L)

Cesare Selli (C)

Alchiede Simonato (A)

Salvatore Siracusano (S)

Carlo Trombetta (C)