Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

BMC Urology

Nicolas Guibert¹  Géraldine Pignot²  Jochen Walz²  Sophie Giusiano³  Dominique Rossi⁴  Yoann Koskas⁴  Cyrille Bastide⁴  François Lannes⁴  Nicolas Branger⁴ 

[1] 0000 0001 2163 3825, grid.413852.9, Centre hospitalier universitaire de Lyon, Lyon, France;0000 0001 2198 4166, grid.412180.e, Hopital Edouard Herriot, 69003, Lyon, France;0000 0004 0598 4440, grid.418443.e, Departement of urology, Institut Paoli-Calmettes, 13008, Marseille, France;0000 0004 1773 6284, grid.414244.3, Department of Anatomic Pathology, Hôpital nord, Chemin des Bourrely, 13015, Marseille, France;0000 0004 1773 6284, grid.414244.3, Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France;

关键词: Prostate cancer;    Radical prostatectomy;    Biochemical recurrence;    Positive surgical margins;    Extent;    Focal positive surgical margins;   

DOI  :  10.1186/s12894-019-0470-8

来源: publisher

【 摘 要 】

BackgroundTo assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up.MethodsThis retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups:- Focal PSM (fPSM): single PSM (sPSM) ≤3 mm;- Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length.ResultsThe median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival (p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001).ConclusionWith a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.

【 授权许可】

CC BY