Buschemeyer W Cooper, Hamilton Robert J, Aronson William J, Presti Joseph C, Terris Martha K, Kane Christopher J, Amling Christopher L, Freedland Stephen J
Department of Surgery (Division of Urologic Surgery), Duke University School of Medicine and Urology Section, Surgical Service, Veterans Affairs Medical Center Durham, Durham, North Carolina 27710, USA.
J Urol. 2008 Jan;179(1):124-9; discussion 129. doi: 10.1016/j.juro.2007.08.130. Epub 2007 Nov 12.
Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings.
We examined 1,722 men from the Shared Equal Access Research Cancer Hospital Database who were treated with radical prostatectomy without lymph node metastases. Time to prostate specific antigen recurrence was compared in men with positive vs negative bladder neck margins using Cox proportional hazards models adjusted for multiple clinical and pathological features.
A positive bladder neck margin in 79 patients (5%) was significantly associated with other poor prognostic features, including higher prostate specific antigen, higher pathological Gleason sum, extracapsular extension, seminal vesicle invasion and other positive margins. After adjusting for clinical and pathological characteristics positive bladder neck margins were associated with an increased risk of prostate specific antigen recurrence (HR 1.52, 95% CI 1.06-2.19, p = 0.02). Relative to organ confined margin negative disease a positive bladder neck margin associated with other positive margins showed a recurrence risk that was similar to that of seminal vesicle invasion (HR 4.14, 95% CI 2.55-6.73 and HR 4.22, 95% CI 3.08-5.78, respectively, each p <0.001). An isolated positive bladder neck margin was a rare event, noted in 15 patients (0.7%). In these men the recurrence risk was difficult to estimate due to the small number. However, the HR was similar to that in men with nonbladder neck positive margins or extracapsular extension (HR 2.65, 95% CI 0.97-7.25, p = 0.06 and HR 2.19, 95% CI 1.71-2.82, p <0.001, respectively).
In the current study a positive bladder neck margin was frequently associated with other adverse features. When it was concomitant with other positive margins, a positive bladder neck margin was associated with a progression risk similar to that of seminal vesicle invasion (T3b disease). Although men with an isolated positive bladder neck margin had a more favorable pathological profile, there were too few of them to assess outcome reliably. However, the limited data suggest that they may best be categorized as having pT3a disease.
根治性前列腺切除术后膀胱颈切缘阳性目前被定为pT4病变。然而，据我们所知，在前列腺特异性抗原时代，膀胱颈切缘阳性的预后意义尚不清楚。我们研究了膀胱颈切缘阳性与前列腺特异性抗原复发之间相对于其他病理结果的关联。
我们研究了共享平等获取研究癌症医院数据库中的1722名男性，他们接受了根治性前列腺切除术且无淋巴结转移。使用针对多种临床和病理特征进行调整的Cox比例风险模型，比较膀胱颈切缘阳性与阴性男性的前列腺特异性抗原复发时间。
79例患者（5%）的膀胱颈切缘阳性与其他不良预后特征显著相关，包括更高的前列腺特异性抗原、更高的病理Gleason评分、包膜外侵犯、精囊侵犯和其他切缘阳性。在调整临床和病理特征后，膀胱颈切缘阳性与前列腺特异性抗原复发风险增加相关（风险比1.52，95%置信区间1.06 - 2.19，p = 0.02）。相对于器官局限性切缘阴性疾病，与其他切缘阳性相关的膀胱颈切缘阳性显示出与精囊侵犯相似的复发风险（风险比分别为4.14，95%置信区间2.55 - 6.73和4.22，95%置信区间3.08 - 5.78，p均<0.001）。孤立的膀胱颈切缘阳性是罕见事件，15例患者（0.7%）出现。由于数量少，这些男性的复发风险难以估计。然而，风险比与非膀胱颈切缘阳性或包膜外侵犯男性相似（风险比分别为2.65，95%置信区间0.97 - 7.25，p = 0.06和2.19，95%置信区间1.71 - 2.82，p <0.001）。
在当前研究中，膀胱颈切缘阳性常与其他不良特征相关。当它与其他切缘阳性同时存在时，膀胱颈切缘阳性与精囊侵犯（T3b疾病）的进展风险相似。尽管孤立膀胱颈切缘阳性的男性病理特征较好，但数量太少无法可靠评估结局。然而，有限的数据表明，他们最好归类为患有pT3a疾病。
