Effects of Positive Surgical Margin in RCC After Adjuvant, Neoadjuvant Therapy

In patients with renal cell carcinoma (RCC), the appearance of positive surgical margin (PSM) has demonstrated a connection with higher risk of cancer-specific mortality (CSM) and recurrence. Previous studies investigating adjuvant therapy in patients with RCC have not included those with PSM.

A recent study from Cesare Saitta, MD, and colleagues sought to determine the effects of PSM on the oncological outcomes of patients with nonmetastatic RCC undergoing treatment with adjuvant or neoadjuvant systemic therapy.

The study was presented at the 2024 American Urological Association Annual Meeting.

For the retrospective, multicenter analysis, researchers adjusted multivariable analysis (MVA) via Cox regression for tumor size, surgery approach, stage, tumor necrosis, tumor grade, and type of systemic therapy. The primary end point was recurrence or progression-free survival (PFS), and the secondary end point was CSM or cancer-specific survival.

Of the 347 participants, 90 were in the adjuvant treatment group, and 257 were in the neoadjuvant group. The median follow-up period was 40 months for the neoadjuvant cohort and 44 months for the adjuvant cohort (P=.33).

MVA found that the presence of PSM (hazard ratio [HR], 2.60; P=.002) in the adjuvant group was an independent risk factor connected with a higher risk of recurrence, while in the neoadjuvant group it was not (P=.065). MVA also determined that PSM (HR, 1.95; P=.048) was an independent risk factor related to a higher risk of CSM in the adjuvant cohort but not in the neoadjuvant group (P=.61).

A comparison of negative surgical margin with PSM found a 5-year PFS difference of 77.4% versus 47.6% in the neoadjuvant cohort and 61.8% versus 16.0% in the adjuvant cohort.

“In a comparison of patients with localized RCC who underwent adjuvant or neoadjuvant systemic therapy, PSM was associated with worsened oncological outcomes after adjuvant systemic therapy, while in the neoadjuvant cohort it was not,” the researchers wrote. “Further investigation is requisite.”