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

BACKGROUND AND

OBJECTIVE

Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery may affect overall survival. This study aims to evaluate Rx rates, identify predictive factors, and assess their impact on overall survival compared to negative margins (R0).

METHODS

We conducted a retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020). Patients underwent partial or radical nephrectomy. The primary outcome was Rx at final pathology. Multivariable logistic regression and Cox proportional hazard regression were employed to identify predictors and assess survival impact.

KEY FINDINGS AND LIMITATIONS: Rx was observed in 0.62% of cases. Partial nephrectomy, laparoscopic approach, and major vein involvement were associated with increased odds of Rx. Rx was linked to worse overall survival (adjusted Hazard Ratio 1.38; 95% CI, 1.22-1.57; P < .01). Limitations include selection bias and data quality variations.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study indicates that Rx should not be considered equivalent to R0 resection status, as it is associated with worse overall survival in RCC. These findings may aid in the postoperative risk assessment of RCC patients and guide clinical decision-making.