The presence of positive surgical margins after nephrectomy for renal cell carcinoma (RCC) is associated with higher recurrence rates and lower survival rates, according to investigators presenting at the 38th Annual Congress of the European Association of Urology (EAU23) in Milan, Italy.
In the INMARC (INternational Marker Consortium for Renal Cancer) registry, 253 of 5112 patients who underwent surgery had positive surgical margins. Of the 253 patients, 114 had stage I, 17 had stage II, 71 had stage III, and 51 had stage IV RCC.
The presence of positive surgical margins was significantly associated with a 2.1-fold increased risk of recurrence, a 2.1-fold increased risk of cancer-specific mortality, and a 1.4-fold increased risk of all-cause mortality, Margaret Meagher, MD, of the University of California San Diego Health System in La Jolla, reported on behalf of her team.
In Kaplan Meier analyses, 5-year recurrence-free survival rates were significantly lower in the group with vs without positive surgical margins across stage I (83% vs 97%), stage II (50% vs 83%), stage III (59% vs 64%), and stage IV RCC (58% vs 78%).
Cancer-specific survival rates at 5 years were significantly lower among patients with vs without positive margins across stage II (37% vs 81%), stage III (61% vs 82%), and stage IV RCC (50% vs 65%), but not stage I disease. Similarly, 5-year overall survival was significantly lower among patients with vs without positive margins across stage II (40% vs 90%), stage III (41% vs 67%), and stage IV RCC (21% vs 39%), but not stage I disease.
“Our findings highlight the need for investigation of adjuvant therapy for stage ≥II RCC patients with [positive surgical margins],” Dr Meagher and colleagues concluded in a study abstract.
Meagher MF, Cerrato C, Patel D, et al. Should adjuvant therapy be considered for positive surgical margins in renal cell carcinoma: A stage-based analysis of impact of positive surgical margins on survival outcomes using the INMARC registry. Presented at: EAU23, Milan, Italy, March 10-13. Abstract A0463.