Antic Tatjana, Taxy Jerome B
From the Department of Pathology, University of Chicago Medicine, Chicago, IL.
Am J Clin Pathol. 2015 May;143(5):645-51. doi: 10.1309/AJCP7LKLZ8JSJQRG.
To evaluate the relationship between a positive resection margin in partial nephrectomy (PN) and local recurrence.
From January 2005 through December 2012, there were 473 PNs in 466 patients at the University of Chicago. A positive margin was defined as tumor extending to the inked specimen edge, either the parenchymal interface or the peripheral fibroadipose tissue. A local recurrence was defined as an ipsilateral tumor of identical histologic type.
Renal cell carcinoma (RCC) accounted for 406 tumors: 243 clear cell RCCs (CRCCs), 77 papillary RCCs (PRCCs), and 47 chromophobe RCCs (CHRCCs). Sixty-one RCCs had positive margins: 43 CRCCs, six PRCCs, nine CHRCCs, and three miscellaneous cell types. Of the 61 positive margins, four CRCCs (all originally multifocal) had a local recurrence, two of which occurred in the same patient. One translocation RCC also recurred. Six cases with negative resection margins had a recurrence.
A literature review of 3,803 cases, including our study, shows positive margins in 173, of which 13 recurred; however, 39 with negative margins also recurred. A positive margin in PN seldom correlates with a local recurrence. However, protection from recurrence is not ensured by a negative margin.
评估部分肾切除术（PN）切缘阳性与局部复发之间的关系。
2005年1月至2012年12月，芝加哥大学466例患者接受了473例PN手术。切缘阳性定义为肿瘤延伸至标本墨染边缘，即实质界面或外周纤维脂肪组织。局部复发定义为同侧出现组织学类型相同的肿瘤。
肾细胞癌（RCC）共406例：243例透明细胞RCC（CRCC）、77例乳头状RCC（PRCC）和47例嫌色细胞RCC（CHRCC）。61例RCC切缘阳性：43例CRCC、6例PRCC、9例CHRCC和3例其他细胞类型。在61例切缘阳性病例中，4例CRCC（均为多灶性）出现局部复发，其中2例发生在同一患者。1例易位性RCC也出现复发。6例切缘阴性病例出现复发。
对包括本研究在内的3803例病例的文献综述显示，173例切缘阳性，其中13例复发；然而，39例切缘阴性者也出现复发。PN切缘阳性很少与局部复发相关。然而，切缘阴性并不能确保预防复发。
