Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality

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• 作者：Min Soo Choo (1)
  Sung Yong Cho (2)
  Kyungtae Ko (3)
  Chang Wook Jeong (1)
  Seung Bae Lee (2)
  Ja Hyeon Ku (1)
  Sung Kyu Hong (4)
  Seok-Soo Byun (4)
  Cheol Kwak (1)
  Hyeon Hoe Kim (1)
  Sang Eun Lee (4)
  Hyeon Jeong (2)
  
• 关键词：Prostatic neoplasms ; Prostatectomy ; Neoplasm ; Residual ; Disease ; free survival ; Robotics
• 刊名：World Journal of Urology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：32
• 期：6
• 页码：1401-1409
• 全文大小：1,268 KB
• 参考文献：1. Blute ML, Bostwick DG, Bergstralh EJ, Slezak JM, Martin SK, Amling CL, Zincke H (1997) Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology 50(5):733-39. doi:10.1016/S0090-4295(97)00450-0 CrossRef
  2. Boorjian SA, Tollefson MK, Thompson RH, Rangel LJ, Bergstralh EJ, Karnes RJ (2012) Natural history of biochemical recurrence after radical prostatectomy with adjuvant radiation therapy. J Urol 188(5):1761-766 CrossRef
  3. Corcoran NM, Hovens CM, Metcalfe C, Hong MK, Pedersen J, Casey RG, Peters J, Harewood L, Goldenberg SL, Costello AJ, Gleave ME (2012) Positive surgical margins are a risk factor for significant biochemical recurrence only in intermediate-risk disease. BJU Int 110(6):821-27. doi:10.1111/j.1464-410X.2011.10868.x CrossRef
  4. Pettus JA, Weight CJ, Thompson CJ, Middleton RG, Stephenson RA (2004) Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol 172(1):129-32. doi:10.1097/01.ju.0000132160.68779.96 CrossRef
  5. Spahn M, Briganti A, Capitanio U, Kneitz B, Gontero P, Karnes JR, Schubert M, Montorsi F, Scholz C-J, Bader P, van Poppel H, Joniau S (2012) Outcome predictors of radical prostatectomy followed by adjuvant androgen deprivation in patients with clinical high risk prostate cancer and pT3 surgical margin positive disease. J Urol 188(1):84-0 CrossRef
  6. Savdie R, Horvath LG, Benito RP, Rasiah KK, Haynes AM, Chatfield M, Stricker PD, Turner JJ, Delprado W, Henshall SM, Sutherland RL, Kench JG (2012) High Gleason grade carcinoma at a positive surgical margin predicts biochemical failure after radical prostatectomy and may guide adjuvant radiotherapy. BJU Int 109(12):1794-800. doi:10.1111/j.1464-410X.2011.10572.x CrossRef
  7. Smith JA Jr, Chan RC, Chang SS, Herrell SD, Clark PE, Baumgartner R, Cookson MS (2007) A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol 178(6):2385-389. doi:10.1016/j.juro.2007.08.008 ; discussion 2389-390 CrossRef
  8. Hegarty NJ, Kaouk JH (2006) Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques. Can J Urol 13(Suppl 1):56-1
  9. Swindle P, Eastham JA, Ohori M, Kattan MW, Wheeler T, Maru N, Slawin K, Scardino PT (2005) Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 174(3):903-07. doi:10.1097/01.ju.0000169475.00949.78 CrossRef
  10. Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB, Han M, Partin AW, Pavlovich CP (2011) Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 107(12):1956-962. doi:10.1111/j.1464-410X.2010.09795.x CrossRef
  11. Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170(5):1738-741. doi:10.1097/01.ju.0000092881.24608.5e CrossRef
  12. Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community sett
• 作者单位：Min Soo Choo (1)
  Sung Yong Cho (2)
  Kyungtae Ko (3)
  Chang Wook Jeong (1)
  Seung Bae Lee (2)
  Ja Hyeon Ku (1)
  Sung Kyu Hong (4)
  Seok-Soo Byun (4)
  Cheol Kwak (1)
  Hyeon Hoe Kim (1)
  Sang Eun Lee (4)
  Hyeon Jeong (2)
  
  1. Department of Urology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
  2. Department of Urology, Seoul National University Boramae Hospital, Sindaebang 2-dong, 395, Dongjak-gu, Seoul, 156-707, Korea
  3. Department of Urology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangding-gu, Seoul, 134-701, Korea
  4. Department of Urology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seongnam, 463-707, Korea
  
• ISSN：1433-8726

文摘

Purpose We investigated the influence of positive surgical margins (PSMs) and their locations on biochemical recurrence (BCR) according to risk stratification and surgical modality. Methods A total of 1,874 post-radical-prostatectomy (RP) patients of pT2–T3a between 2000 and 2010 at three tertiary centers, and who did not receive neoadjuvant/adjuvant therapy, were included in this study. Patients were stratified according to BCR risk: low risk (PSA 20 or pT3a or pGS 8-0). The median follow-up was 43?months. Results PSMs were a significant predictor of BCR in both the intermediate- and high-risk-disease groups (P?=?.001, HR 2.1, 95?% CI 1.3-.4; P?P?=?.003, HR 2.0, 95?% CI 1.2-.3), but not in intermediate-risk disease (P?=?.06, HR 1.7, 95?% CI 0.9-.1). Positive bladder neck margin was a significant risk factor for BCR in both intermediate- and high-risk disease (P?P?=?.001, HR 4.5, 95?% CI 1.8-1.4). In subgroup analyses, robotic RP provided comparable BCR-free survival regardless of risk stratification. Patients with PSMs showed similar BCR-free survival between open and robotic RP (log-rank, P?=?.897). Conclusions Post-RP PSMs were a significantly independent predictor of disease progression in high-risk disease as well as intermediate-risk disease. Both positive apical and bladder neck margins are also significant risk factors of BCR in high-risk disease. Patients with PSMs showed similar BCR-free survival between open and robotic surgery.