Saether Thorstein, Sørlien Lars Tjugum, Viset Trond, Lydersen Stian, Angelsen Anders
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Scand J Urol Nephrol. 2008;42(6):514-21. doi: 10.1080/00365590802299585.
A positive surgical margin (PSM) is considered an adverse prognostic indicator in patients undergoing radical prostatectomy (RP). However, there are discrepancies among studies concerning the effect of PSM on prognosis. In addition, the significance of PSM location and extent is uncertain. The aim of this study was to examine the impact of surgical margin status on serum prostate-specific antigen (sPSA) relapse in men consecutively receiving RP in a non-screened population.
In total, 219 prostatectomy specimens were examined microscopically. The mean follow-up time was 62 months (range 6-121 months). Tumour grade (Gleason score), pathological tumour stage and tumour involvement of the surgical margins were recorded. The 71 specimens with one or more PSM were re-examined with regard to location, number of locations and total linear extent of PSM. Kaplan-Meier plots and Cox proportional hazards regression were used in the univariate analyses. Multivariate analyses controlling for the known preoperative sPSA, pathological stage and Gleason score were also performed, using Cox proportional hazards regression.
In the univariate analyses, PSM without regard to location, PSM at the anterior prostate or at the apex, PSM at three or more locations and linear extent of PSM > or =6mm were associated with a statistically significant higher hazard ratio of PSA relapse. However, none of these variables remained statistically significant when controlling for the known risk factors.
In this non-screened prostate cancer population PSM status (linear extent, location and number of locations) had an impact on postoperative sPSA recurrence. In multivariate analyses PSM showed a strong trend (p approximately 0.06) towards having an independent statistically significant negative influence on the risk of PSA relapse following RP.
在接受根治性前列腺切除术（RP）的患者中，手术切缘阳性（PSM）被视为不良预后指标。然而，关于PSM对预后影响的研究存在差异。此外，PSM的位置和范围的意义尚不确定。本研究的目的是在未经筛查的人群中，研究手术切缘状态对连续接受RP的男性血清前列腺特异性抗原（sPSA）复发的影响。
共对219份前列腺切除标本进行显微镜检查。平均随访时间为62个月（范围6 - 121个月）。记录肿瘤分级（Gleason评分）、病理肿瘤分期和手术切缘的肿瘤累及情况。对71份有一个或多个PSM的标本重新检查PSM的位置、位置数量和总线性范围。单因素分析采用Kaplan-Meier曲线和Cox比例风险回归。还使用Cox比例风险回归进行多因素分析，控制已知的术前sPSA、病理分期和Gleason评分。
在单因素分析中，不考虑位置的PSM、前列腺前部或尖部的PSM、三个或更多位置的PSM以及PSM线性范围>或 =6mm与PSA复发的统计学显著较高风险比相关。然而，在控制已知风险因素后，这些变量均无统计学显著性。
在这个未经筛查的前列腺癌人群中，PSM状态（线性范围、位置和位置数量）对术后sPSA复发有影响。在多因素分析中，PSM显示出对RP后PSA复发风险有独立统计学显著负面影响的强烈趋势（p约为0.06）。
