Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BJU Int. 2010 Aug;106(4):478-83. doi: 10.1111/j.1464-410X.2009.09162.x. Epub 2010 Jan 29.
To identify risk factors of a positive surgical margin (PSM) and the significance of a PSM after radical prostatectomy (RP) on biochemical recurrence (BCR) in exclusively pathologically confirmed organ-confined (OC) prostate cancer, as despite an excellent prognosis after RP, some patients with pathologically confirmed OC disease have BCR, and the prognostic significance of a PSM in these men remains unclear.
We assessed 932 men with pathologically OC disease who were treated with RP by nine different surgeons between 1992 and 2004. The prognostic significance of clinical and pathological variables, including tumour volume (TV) and percentage of high-grade TV (%HGTV) were assessed. Logistic and Cox regression models were fitted to identify risk factors of a PSM and BCR. BCR was defined as a prostate-specific antigen (PSA) level of 0.1 ng/mL and increasing after an undetectable PSA level.
The total PSM rate was 12.9% (120 men); the mean TV (P < 0.001), but not %HGTV (P= 0.2) was significantly higher in patients with PSM. TV, nerve-sparing RP technique and surgical volume were independent risk factors for a PSM (P= 0.03). After a median follow-up of 35 months the overall BCR rate was 8.8% (82 men). Patients with a PSM had significantly higher BCR rates (21.7% vs 6.9%; P < 0.001). In univariable analysis, a high %HGTV (70.4%) was the most informative risk factor of BCR, followed by RP Gleason score (65.8%) and PSM (65.7%). Removal of PSM from a multivariable Cox model decreased the accuracy by 12.1% (P < 0.001).
Our findings show that in OC prostate cancer, the risk of a PSM depends on TV, surgical technique and surgical volume. PSM is a significant risk factor for BCR. However, only 20% men with OC disease and a PSM develop BCR; conversely, 80% of men are cured despite a PSM. Therefore, adjuvant therapy must be considered, with caution to avoid unnecessary overtreatment.
确定根治性前列腺切除术（RP）后病理完全局限于前列腺（OC）的前列腺癌患者出现阳性切缘（PSM）的风险因素以及 PSM 对生化复发（BCR）的意义，因为尽管 RP 后预后良好，但一些病理证实 OC 疾病的患者仍会发生 BCR，而这些患者中 PSM 的预后意义仍不清楚。
我们评估了 932 名在 1992 年至 2004 年间由 9 位不同外科医生进行 RP 治疗的病理 OC 疾病患者。评估了临床和病理变量（包括肿瘤体积（TV）和高级别 TV 百分比（%HGTV））的预后意义。使用逻辑和 Cox 回归模型来确定 PSM 和 BCR 的风险因素。BCR 定义为 PSA 水平为 0.1ng/ml 且在 PSA 水平不可检测后升高。
PSM 总发生率为 12.9%（120 人）；PSM 患者的平均 TV（P<0.001），但 %HGTV 无显著差异（P=0.2）。TV、保留神经的 RP 技术和手术量是 PSM 的独立危险因素（P=0.03）。中位随访 35 个月后，总 BCR 率为 8.8%（82 人）。PSM 患者的 BCR 发生率显著更高（21.7% vs 6.9%；P<0.001）。单变量分析显示，高 %HGTV（70.4%）是 BCR 的最具信息量的危险因素，其次是 RP Gleason 评分（65.8%）和 PSM（65.7%）。多变量 Cox 模型中删除 PSM 降低了 12.1%的准确性（P<0.001）。
我们的研究结果表明，在 OC 前列腺癌中，PSM 的风险取决于 TV、手术技术和手术量。PSM 是 BCR 的显著危险因素。然而，只有 20%的 OC 疾病和 PSM 患者发生 BCR；相反，尽管有 PSM，80%的患者仍被治愈。因此，必须考虑辅助治疗，但要谨慎，避免不必要的过度治疗。
