Positive surgical margins may not affect the survival of patients with renal cell carcinoma after partial nephrectomy: A meta-analysis based on 39 studies

Abstract

BackgroundSo far, whether positive surgical margin(PSM) has adverse effects on the prognosis of patients is still controversial, so we designed this study to systematically evaluate the effect of PSM on the prognosis of patients with renal cell carcinoma (RCC) after partial nephrectomy (PN).MethodsOn the basis of three electronic databases (PubMed, Embase and the Cochrane Library) up to May 2022, all case–control studies (CCSs) comparing the effects of PSM and negative surgical margin (NSM) after PN on the oncological results of RCC patients were included. Two evaluators independently conducted a systematic literature search and extracted the data we needed. The methodological quality of all studies was evaluated by the modified Newcastle–Ottawa scale. The odds ratio (OR) was used to describe the results for dichotomous variables, and the meta-analysis was conducted using Cochrane Review Manager 5.2 and Stata 14.2.ResultsA total of 39 studies involving 21461 patients were included in our meta-analysis. The pooled results showed that the rates of tumor recurrence (OR 3.93, 95% CI 2.95-5.24; p < 0.00001) and metastasis (OR 4.63, 95% CI 3.11-6.88; p < 0.00001) in the PSM group were significantly higher than those in the NSM group. However, there were no significant differences in the rates of all-cause death (OR 1.35, 95% CI 0.92-1.99; p = 0.13) or cancer-specific death (OR 0.99, 95% CI 0.51-1.94; p = 0.99) between the two groups. In addition, subgroup analyses were carried out according to different average follow-ups, which revealed similar results.ConclusionInsignificant differences in survival between the PSM and NSM groups were observed, although significant differences in recurrence and metastasis in the PSM group were reported. Our study supported that close monitoring might be another effective choice for patients with PSM after PN. Considering the possible limitations, we recommended cautious interpretation of our results.

The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study

“…However, the 5-year overall survival rates did not significantly differ between the two groups. This may suggest that while PSM is a strong predictor of recurrence, it may not independently predict overall survival, a phenomenon that has been observed in other studies [1,[14][15][16][17][18][19]. This could be attributed to the indolent nature of some RCC cases, where recurrence does not immediately translate to a survival disadvantage.…”

The Impact of Metastasectomy on Survival Outcomes of Renal Cell Carcinoma: A 10-Year Single Center Experience

“…However, in the present series, ccRCC variant histology and bilateral disease did not impact on OS probability upon univariable analysis ( p = 0.052 and p = 0.471, respectively). The positive surgical margin rate is considered an independent predictor of disease recurrence after nephron-sparing surgery for RCC ( p = 0.013) [ 32 ], while the impact of PSM on OS probabilities is negligible in the literature [ 33 ] as well as in the present study (univariable Cox p = 0.953). Concerning metastatic sites, Abdel-Rahman [ 34 ] evaluated the clinical and prognostic value of metastatic sites in mRCC; the author reported that patients with liver metastases of RCC have worse outcomes and worst OS compared to cases who developed other sites of metastases.…”