Does Preoperative Renal Tumour Biopsy Impact Trifecta Achievement in Partial Nephrectomy?

Abstract

Purpose We aimed to evaluate the effect of renal tumour biopsy (RTB) on trifecta criteria achievement in patients treated with open partial nephrectomy (OPN).

Methods Patients who were diagnosed with renal cancer and underwent OPN between 2012 and 2023 were retrospectively reviewed. The RTB group consisted of patients who underwent RTB before OPN, while the non-RTB group consisted of those who did not undergo RTB. No matching method was employed since parameters such as tumour size and Padua score were comparable between the two groups. The primary outcome was trifecta achievement, defined as negative surgical margins, warm ischemia time (WIT) <25 minutes, and no complications. Secondary outcomes were the clinicopathologic and survival outcomes of both groups.

Results There were 137 (82.03%) patients in the non-RTB group and 30 (17.96%) patients in the RTB group. The median postoperative follow-up was 45 (24–141) months. The median tumour size was 3.4 (1–7) cm and 3 (1.4–7) cm in the non-RTB group and RTB group, respectively (p=0.282). Seventy-five of the 137 (54.76%) patients in the non-RTB group and 16 of the 30 (53.3%) patients in the RTB group achieved the trifecta criteria (p=0.878). There was no statistically significant difference between the two groups in terms of metastasis-free survival (p=0.332) or overall survival (p=0.359) at 24 months. The rate of intraparenchymal lymphovascular invasion was significantly higher in the RTB group (16.6%) than in the non-RTB group (2.92%) (p=0.013).

Conclusions Our study indicated that trifecta achievement rates were comparable between patients who did and those who did not undergo RTB. Consequently, RTB can be safely performed in renal cancer.

Zusammenfassung

Zweck Unser Ziel war es, die Auswirkungen der Nierentumorbiopsie (NB) auf das Erreichen der Trifecta-Kriterien bei Patienten zu untersuchen, die einer offenen partiellen Nephrektomie (OPN) unterzogen wurden.

Methoden Es wurde eine retrospektive Analyse von Patienten durchgeführt, bei denen zwischen 2012 und 2023 Nierenkrebs diagnostiziert wurde und die einer offenen partiellen Nephrektomie (OPN) unterzogen wurden. Die NB-Gruppe umfasste Patienten, bei denen vor der OPN eine Nierentumorbiopsie (NB) durchgeführt wurde, während die Nicht-NB-Gruppe aus Patienten bestand, bei denen keine NB durchgeführt wurde. Es wurde keine Matching-Methode angewendet, da Parameter wie Tumorgröße und der Padua-Score zwischen den beiden Gruppen vergleichbar waren. Das primäre Ziel war das Erreichen der Trifecta, definiert durch negative chirurgische Ränder, eine warme Ischämiezeit (WIT) von weniger als 25 Minuten und das Fehlen von Komplikationen. Das sekundäre Ziel umfassten klinikopathologische Merkmale sowie Überlebensdaten beider Gruppen.

Ergebnisse Es gab insgesamt 137 Patienten (82,03%) in der Nicht-NB-Gruppe und 30 Patienten (17,96%) in der NB-Gruppe. Die mediane postoperative Nachbeobachtungszeit betrug 45 Monate (Spanne: 24–141 Monate). Die mediane Tumorgröße betrug 3,4 cm (Spanne: 1–7 cm) in der Nicht-NB-Gruppe und 3 cm (Spanne: 1,4–7 cm) in der NB-Gruppe. Von den 137 Patienten in der Nicht-NB-Gruppe erfüllten 75 (54,76%) die Trifecta-Kriterien, während dies bei 16 von 30 Patienten (53,3%) in der NB-Gruppe der Fall war (p=0,878). Es wurden keine statistisch signifikanten Unterschiede zwischen den beiden Gruppen hinsichtlich der metastasenfreien Überlebensrate (p=0,332) oder des Gesamtüberlebens (p=0,359) im 24. Monat festgestellt. Die Rate der intraparenchymalen lymphovaskulären Invasion war in der NB-Gruppe signifikant höher (16,6%) im Vergleich zur Nicht-NB-Gruppe (2,92%) (p=0,013).

Schlussfolgerungen Unsere Studie deutete darauf hin, dass die Erfolgsraten der Trifecta bei den Patienten, die sich einer NB unterzogen hatten, vergleichbar waren mit denen, die dies nicht taten. Folglich kann eine NB sicher bei Nierenkrebs durchgeführt werden.

Keywords

nephrectomy - trifecta - biopsy - renal cell cancer

Schlüsselwörter

Nephrektomie - trifecta - biopsie - Nierenzellkrebs

Publication History

Received: 23 June 2024

Accepted after revision: 21 October 2024

Article published online:
27 November 2024

• References

• 1 Capitanio U, Bensalah K, Bex A. et al. Epidemiology of renal cell carcinoma. European Urology  2019; 75: 74-84
• 2 Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin 2018; 68: 7-30
• 3 Hollingsworth JM, Miller DC, Daignault S. et al. Rising incidence of small renal masses: A need to reassess treatment effect. J Natl Cancer Inst 2006; 98: 1331-1334
• 4 Novick AC. Laparoscopic and partial nephrectomy. Clinical Cancer Research 2004; 10: 6322S-6327S
• 5 Campbell S, Uzzo RG, Allaf ME. et al. Renal Mass and Localized Renal Cancer: AUA Guideline. J Urol 2017; 198: 520-529
• 6 Kim JH, Li S, Khandwala Y. et al. Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014. JAMA Surg 2019; 154: 225-231
• 7 Daugherty M, Sedaghatpour D, Shapiro O. et al. The metastatic potential of renal tumors: Influence of histologic subtypes on definition of small renal masses, risk stratification, and future active surveillance protocols. Urol Oncol 2017; 35: 153.e115-153.e120
• 8 Pasquier D, Rozet F, Fregeville A. et al. Renal tumor biopsy does not increase the risk of surgical complications of minimally invasive partial nephrectomy. Prog Urol 2022; 32: 843-848
• 9 Asselin C, Finelli A, Breau RH. et al. Does renal tumor biopsies for small renal carcinoma increase the risk of upstaging on final surgery pathology report and the risk of recurrence?. Urol Oncol 2020; 38: 798.e9-798.e16
• 10 Macklin PS, Sullivan ME, Tapping CR. et al. Tumour seeding in the tract of percutaneous renal tumour biopsy: A report on seven cases from a UK tertiary referral centre. Eur Urol 2019; 75: 861-867
• 11 Hung AJ, Cai J, Simmons MN. et al. "Trifecta" in partial nephrectomy. J Urol 2013; 189: 36-42
• 12 Khalifeh A, Autorino R, Hillyer SP. et al. Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial ne- phrectomy cases: a single surgeon experience. J Urol 2013; 189: 1236-1242
• 13 Moch H, Amin MB, Berney DM. The 2022 World Health Organization classification of tumours of the urinary system and male genital organs – part A: renal, penile, and testicular tumours. Eur Uro 2022; 82: 458-468
• 14 Amin MB, Greene FL, Edge SB. et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin 2017; 67: 93-99
• 15 Buffi N, Lista G, Larcher A. et al. Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol 2012; 62: 617-618
• 16 Khalifeh A, Autorino R, Eyraud R. et al. Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. Eur Urol 2013; 64: 744-750
• 17 Rothberg MB, Peak TC, Reynolds CR. et al. Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy. Transl Androl Urol 2020; 9: 879-886
• 18 Radfar MH, Ameri F, Dadpour M. et al. Partial nephrectomy and positive surgical margin, oncologic outcomes and predictors: a 15-year single institution experience. Cent European J Urol 2021; 74: 516-522
• 19 Sorbellini M, Kattan MW, Snyder ME. A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. J Urol 2005; 173: 48-51
• 20 Kroeger N, Rampersaud EN, Patard JJ. et al. Prognostic value of microvascular invasion in predicting the cancer specific survival and risk of metastatic disease in renal cell carcinoma: a multicenter investigation. J Urol 2012; 187: 418-423
• 21 Houvenaeghel G, Cohen M, Classe JM. et al. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open 2021; 6: 100316
• 22 Belsante M, Darwish O, Youssef R. et al. Lymphovascular invasion in clear cell renal cell carcinoma – association with disease-free and cancer-specific survival. Urol Oncol 2014; 32: 30.e23-30.e28
• 23 Bedke J, Heide J, Ribback S. Microvascular and lymphovascular tumour invasion are associated with poor prognosis and metastatic spread in renal cell carcinoma: a validation study in clinical practice. BJU Int 2018; 121: 84-92
• 24 Rakic I, Rakic N, Stephens A. et al. Assessing the impact of lymphovascular invasion on overall survival in surgically treated renal cell carcinoma patients: A nationwide cohort analysis. Urol Oncol 2023; 41: 435.e1-435.e9
• 25 Mearini L, Nunzi E, Vianello A. et al. Margin and complication rates in clampless partial nephrectomy: a comparison of open, laparoscopic and robotic surgeries. J Robot Surg 2016; 10: 135-144
• 26 Cacciamani GE, Medina LG, Gill TS. et al. Impact of Renal Hilar Control on Outcomes of Robotic Partial Nephrectomy: Systematic Review and Cumulative Meta-analysis. Eur Urol Focus 2019; 5: 619-635
• 27 Thompson RH, Lane BR, Lohse CM. et al. Every minute counts when the renal hilum ıs clamped during partial nephrectomy. Eur Urol 2019; 58: 340-345
• 28 Mir MC, Campbell RA, Sharma N. et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology 2013; 82: 263-268