Location, extent, and multifocality of positive surgical margins for biochemical recurrence prediction after radical prostatectomy

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• 作者：Guillaume Ploussard (1)
  Sarah J. Drouin (1)
  Julie Rode (1)
  Yves Allory (1)
  Dimitri Vordos (1)
  Andras Hoznek (1)
  Claude-Clément Abbou (1)
  Alexandre de la Taille (1)
  Laurent Salomon (1)
  
• 关键词：Radical prostatectomy ; Margin ; Prostate cancer ; PSA failure ; Oncologic outcomes
• 刊名：World Journal of Urology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：32
• 期：6
• 页码：1393-1400
• 全文大小：571 KB
• 参考文献：1. Eastham JA, Kattan MW, Riedel E, Begg CB, Wheeler TM, Gerigk C et al (2003) Variations among individual surgeons in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 170:2292-295 CrossRef
  2. Fitzsimons NJ, Presti JC Jr, Kane CJ, Terris MK, Aronson WJ, Amling CL et al (2006) Is biopsy Gleason score independently associated with biochemical progression following radical prostatectomy after adjusting for pathological Gleason score? J Urol 176:2453-458 CrossRef
  3. Hernandez DJ, Epstein JI, Trock BJ, Tsuzuki T, Carter HB, Walsh PC (2005) Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle? J Urol 173:446-49 CrossRef
  4. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Schnall M, Tomaszewski JE et al (1995) A multivariate analysis of clinical and pathological factors that predict for prostate specific antigen failure after radical prostatectomy for prostate cancer. J Urol 154:131-38 CrossRef
  5. Karakiewicz PI, Eastham JA, Graefen M, Cagiannos I, Stricker PD, Klein E et al (2005) Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients. Urology 66:1245-250 CrossRef
  6. Wright JL, Dalkin BL, True LD et al (2010) Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol 183:2213-218 CrossRef
  7. Vis A, Schroder FH, van der Kwast TH (2006) The actual value of the surgical margin status as a predictor of disease progression in men with early prostate cancer. Eur Urol 50:258-65 CrossRef
  8. Freedland SJ, Aronson W, Presti JC Jr et al (2003) Should a positive surgical margin following radical prostatectomy be pathological stage T2 or T3? Results from the SEARCH database. J Urol 169:2142-161 CrossRef
  9. Salomon L, Anastasiadis AG, Levrel O, Katz R, Saint F, de la Taille A et al (2003) Location of positive surgical margins after retropubic, perineal, and laparoscopic radical prostatectomy for organ-confined prostate cancer. Urology 61:386-90 CrossRef
  10. Stephenson AJ, Wood DP, Kattan MW, Klein EA, Scardino PT, Eastham JA et al (2009) Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. J Urol 182:1357-363 CrossRef
  11. Mauermann J, Fradet V, Lacombe L, Dujardin T, Tiguert R, Tetu B et al (2013) The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol 64:19-5 CrossRef
  12. Tan PH, Cheng L, Srigley JR, Griffiths D, Humphrey PA, van der Kwast TH et al (2011) ISUP Prostate Cancer Group. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins. Mod Pathol 24:48-7 CrossRef
  13. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL (2005) ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 29:1228-242 CrossRef
  14. Udo K, Cronin AM, Carlino LJ,
• 作者单位：Guillaume Ploussard (1)
  Sarah J. Drouin (1)
  Julie Rode (1)
  Yves Allory (1)
  Dimitri Vordos (1)
  Andras Hoznek (1)
  Claude-Clément Abbou (1)
  Alexandre de la Taille (1)
  Laurent Salomon (1)
  
  1. Department of Urology and Pathology, Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
  
• ISSN：1433-8726

文摘

Purpose To study the prognostic value of extent, number, and location of positive surgical margins (PSM). Methods A total of 1,504 consecutive adjuvant treatment naive and node-negative radical prostatectomy men were included in a prospective database including extent, number, and location of PSM. Mean follow-up was 33?months. Endpoint was biochemical progression-free (bPFS) survival. The impact of margin status and characteristics was assessed in time-dependent analyses using Cox regression and Kaplan–Meier methods. Results PSM was reported in 26.7?% of patients. The predominant PSM locations were apex and posterior locations. Median PSM length was 4.0?mm. The 2-year bPFS was 73.7?% in PSM patients as compared to 93.0?% in NSM patients (p?p?p?=?0.017, coefficient: ?.122). In univariable analysis, extent and number of PSM were significantly linked to outcomes. None of PSM subclassifications significantly influenced the bPFS rates in the subgroup of pT2 disease patients. Conversely, stratification by PSM location (apex vs. other locations, p?=?0.008), by PSM number (p?=?0.006), and by PSM length (p?p?=?0.005). Conclusions PSM subclassifications do not improve the biochemical recurrence prediction in organ-confined disease. In non-organ-confined disease, PSM length (??mm), multifocality (? sites), and apical location are significantly linked to poorer outcomes and could justify a more aggressive adjuvant treatment approach.