Pettus Joseph A, Weight Christopher J, Thompson Clinton J, Middleton Richard G, Stephenson Robert A
Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
J Urol. 2004 Jul;172(1):129-32. doi: 10.1097/01.ju.0000132160.68779.96.
The significance of isolated positive apical surgical margins in radical retropubic prostatectomy (RRP) specimens remains controversial. We examine the effects of margin status and location on biochemical recurrence rates in patients undergoing RRP.
Of 800 patients with RRP we identified 498 without pathological evidence of lymph node, seminal vesicle or adjacent organ involvement and with at least 6 months of followup. Patients were subdivided into apex only positive (AM+), nonapical isolated positive (OM+), multiple positive (MM+) and negative (SM-) surgical margins. The rate and interval to biochemical disease recurrence were determined in each group. Univariate and multivariate analysis as well as Kaplan-Meier curves were used to test differences among these groups.
Of the 498 men who met our inclusion criteria 400 were SM-, 28 were AM+, 57 were OM+ and 13 were MM+ at a median followup of 49, 59, 64 and 83 months, respectively. Biochemical recurrence rates for SM-, AM+, OM+ and MM+ were 9.3%, 21.4%, 26.3% and 30.8%, respectively. Median time to biochemical failure in the SM-, AM+, OM+ and MM+ groups was 34, 19.5, 46.0 and 6.8 months, respectively. Biochemical recurrence was not statistically different among the AM+, OM+ and MM+ groups. On univariate analysis AM+, OM+ and MM+ were significant predictors of recurrence (p < 0.05, < 0.005, and <0.05, respectively). On multivariate models only pretreatment prostate specific antigen and OM+ were independent predictors of biochemical recurrence.
A positive surgical margin conveys increased risk for biochemical recurrence. Patients with AM+ experienced biochemical recurrence more frequently and rapidly than those with SM-. AM+ conveys a similar risk of recurrence compared with OM+ and MM+. Apical margin status did not independently predict biochemical recurrence.
耻骨后根治性前列腺切除术（RRP）标本中孤立的阳性切缘的意义仍存在争议。我们研究了切缘状态和位置对接受RRP患者生化复发率的影响。
在800例行RRP的患者中，我们确定了498例无淋巴结、精囊或邻近器官受累的病理证据且随访至少6个月的患者。患者被分为仅尖部阳性（AM+）、非尖部孤立阳性（OM+）、多处阳性（MM+）和阴性（SM-）手术切缘。确定每组生化疾病复发的发生率和间隔时间。采用单因素和多因素分析以及Kaplan-Meier曲线来检验这些组之间的差异。
在符合我们纳入标准的498名男性中，分别有400例为SM-、28例为AM+、57例为OM+和13例为MM+，中位随访时间分别为49、59、64和83个月。SM-、AM+、OM+和MM+组的生化复发率分别为9.3%、21.4%、26.3%和30.8%。SM-、AM+、OM+和MM+组生化失败的中位时间分别为34、19.5、46.0和6.8个月。AM+、OM+和MM+组之间生化复发无统计学差异。单因素分析中，AM+、OM+和MM+是复发的显著预测因素（分别为p<0.05、<0.005和<0.05）。在多因素模型中，仅术前前列腺特异性抗原和OM+是生化复发的独立预测因素。
阳性手术切缘会增加生化复发的风险。AM+患者比SM-患者更频繁、更快地发生生化复发。与OM+和MM+相比，AM+的复发风险相似。尖部切缘状态不能独立预测生化复发。
