Rabbani Farhang, Vora Kinjal C, Yunis Luis Herran, Eastham James A, Guillonneau Bertrand, Scardino Peter T, Touijer Karim
Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
BJU Int. 2009 Sep;104(5):605-10. doi: 10.1111/j.1464-410X.2009.08757.x.
To determine the biochemical recurrence (BCR) rate in patients with positive surgical margins (PSMs) on the prostate specimen who have additional negative tissue resected from that site (M+ -), compared to patients with negative margins (M-) and those with persistent PSM (M+), as those with PSM at radical prostatectomy (RP) are at greater risk of BCR, and in some instances where suspicious tissue is noted in the prostate bed or when frozen-section analysis shows PSM, additional tissue is resected from the suspect site of the PSM.
Between January 1999 and June 2007, 4217 consecutive patients underwent open or laparoscopic RP with no previous radiotherapy or hormonal therapy. The median (interquartile range) follow-up was 37.4 (21.1-60.7) months.
Pathological organ-confined (OC) cancer was present in 2901 men, of whom 2659 had M-, 216 had M+, and 26 had M+-. Extracapsular extension (ECE) alone with no seminal vesicle or lymph node involvement was present in 843 men, of whom 657 had M-, 174 had M+ and 12 had M+-. For patients with OC cancer, the 36-month actuarial BCR-free probability was 97.9% (95% confidence interval 97.3-98.5) for M-, vs 89.0 (84.1-93.9)% for M+ vs 100% for M+-. For patients with ECE, the 36-month actuarial BCR-free probability was 83.7 (80.0-87.4)% for M- vs 73.7 (66.1-81.3)% for M+ vs 90.0 (71.4-100)% for M+-. The main limitation of the study was its retrospective nature, with the reason for resection of additional tissue not always well documented.
While the few patients with PSMs and further negative resected tissue limited the statistical analysis, it would appear that in these patients the disease behaves as in those with negative margins.
确定前列腺标本手术切缘阳性（PSM）且从该部位额外切除阴性组织（M + -）的患者的生化复发（BCR）率，并与手术切缘阴性（M -）和持续存在PSM（M +）的患者进行比较。因为在根治性前列腺切除术（RP）中存在PSM的患者发生BCR的风险更高，并且在某些情况下，当在前列腺床发现可疑组织或冰冻切片分析显示PSM时，会从PSM的可疑部位额外切除组织。
1999年1月至2007年6月期间，4217例连续患者接受了开放性或腹腔镜RP，之前未接受过放疗或激素治疗。中位（四分位间距）随访时间为37.4（21.1 - 60.7）个月。
2901名男性存在病理器官局限性（OC）癌，其中2659例为M -，216例为M +，26例为M + -。843名男性仅存在包膜外侵犯（ECE），无精囊或淋巴结受累，其中657例为M -，174例为M +，12例为M + -。对于OC癌患者，M -组36个月的无BCR精算概率为97.9%（95%置信区间97.3 - 98.5），M +组为89.0（84.1 - 93.9）%，M + -组为100%。对于ECE患者，M -组36个月的无BCR精算概率为83.7（80.0 - 87.4）%，M +组为73.7（66.1 - 81.3）%，M + -组为90.0（71.4 - 100）%。该研究的主要局限性在于其回顾性性质，额外组织切除的原因并非总是记录完整。
虽然少数PSM且有进一步阴性切除组织的患者限制了统计分析，但似乎这些患者的疾病表现与切缘阴性的患者相同。
