Castilla Elias A, Liou Louis S, Abrahams Neil A, Fergany Amr, Rybicki Lisa A, Myles Jonathan, Novick Andrew C
Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Urology. 2002 Dec;60(6):993-7. doi: 10.1016/s0090-4295(02)01983-0.
To examine the relationship between the width of the resection margin and disease progression in renal cell carcinoma (RCC) after nephron-sparing surgery (NSS). During NSS for RCC, it is standard practice to excise the tumor along with a surrounding margin of normal parenchyma (margin of resection) to ensure complete resection of the neoplasm. However, no agreement has been reached on how wide the margin of resection should be.
We retrospectively reviewed the histopathologic sections and medical records of 69 patients with localized RCC who had undergone NSS between 1976 and 1988 to determine whether the resection margin, tumor size, TNM stage, and Fuhrman nuclear grade were associated with disease progression (defined as local tumor recurrence or metastasis). The mean postoperative follow-up interval was 8.5 years.
No association was found between the width of the resection margin and disease progression (P = 0.98, log-rank test). Both TNM stage and Fuhrman nuclear grade correlated with disease progression. Patients with T1-T2 tumors had lower progression (P <0.001, log-rank test), and increased Fuhrman nuclear grade correlated with more disease progression (P <0.001, log-rank test).
The width of the resection margin after NSS for RCC does not correlate with long-term disease progression. A histologic tumor-free margin of resection, irrespective of the width of the margin is sufficient to achieve complete local excision of RCC.
探讨保留肾单位手术（NSS）治疗肾细胞癌（RCC）后切缘宽度与疾病进展之间的关系。在对RCC进行NSS时，标准做法是切除肿瘤及其周围正常实质边缘（切缘），以确保肿瘤完全切除。然而，对于切缘应多宽尚未达成共识。
我们回顾性分析了1976年至1988年间接受NSS的69例局限性RCC患者的组织病理学切片和病历，以确定切缘、肿瘤大小、TNM分期和Fuhrman核分级是否与疾病进展（定义为局部肿瘤复发或转移）相关。术后平均随访时间为8.5年。
未发现切缘宽度与疾病进展之间存在关联（P = 0.98，对数秩检验）。TNM分期和Fuhrman核分级均与疾病进展相关。T1-T2期肿瘤患者的疾病进展率较低（P <0.001，对数秩检验），Fuhrman核分级增加与疾病进展增加相关（P <0.001，对数秩检验）。
RCC患者NSS后的切缘宽度与长期疾病进展无关。无论切缘宽度如何，无肿瘤组织学切缘足以实现RCC的完全局部切除。
