Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA.
J Urol. 2010 Jun;183(6):2213-8. doi: 10.1016/j.juro.2010.02.017.
Positive surgical margins in men undergoing radical prostatectomy for prostate cancer are associated with an increased risk of biochemical recurrence. Few data are available on the role of positive surgical margins in prostate cancer specific mortality. Using a large, population based national cancer registry we evaluated the risk of prostate cancer specific mortality associated with margin status.
The SEER cancer registry data for patients diagnosed between 1998 and 2006 were used to identify men undergoing radical prostatectomy for prostate cancer. Margin status, pathological stage, Gleason grade and postoperative radiation therapy were recorded along with demographic data. Multivariate Cox regression analysis was used to estimate the risk of prostate cancer specific mortality associated with positive surgical margins.
A total of 65,633 patients comprised the cohort in which 291 (0.44%) prostate cancer specific deaths occurred during an average followup of 50 months. Positive surgical margins were reported in 21.2% of cases and were more common in pT3a than pT2 tumors (44% vs 18%, p <0.001) and higher grade tumors (28% vs 18%, p <0.001). The 7-year disease specific survival rates for those at highest risk for prostate cancer specific mortality (higher grade pT3a) were 97.6% for cases with negative surgical margins and 92.4% for those with positive surgical margins. Positive surgical margins were associated with a 2.6-fold increased unadjusted risk of prostate cancer specific mortality (HR 2.55, 95% CI 2.02-3.21). Positive surgical margins remained an independent predictor of prostate cancer specific mortality on multivariate analysis (HR 1.70, 95% CI 1.32-2.18).
These data demonstrate the independent role of positive surgical margins in prostate cancer specific mortality. These findings support the importance of optimizing surgical techniques to achieve a sound oncological surgical outcome with negative surgical margins when possible.
在接受根治性前列腺切除术治疗前列腺癌的男性中，阳性手术切缘与生化复发风险增加相关。关于阳性手术切缘在前列腺癌特异性死亡率中的作用，数据有限。本研究使用大型基于人群的国家癌症登记处，评估了与切缘状态相关的前列腺癌特异性死亡率的风险。
使用 SEER 癌症登记处的数据，对 1998 年至 2006 年间诊断为前列腺癌的患者进行了识别，以确定接受根治性前列腺切除术的患者。记录了切缘状态、病理分期、Gleason 分级和术后放疗情况，以及人口统计学数据。采用多变量 Cox 回归分析来估计与阳性手术切缘相关的前列腺癌特异性死亡率的风险。
共纳入 65633 例患者，其中在平均 50 个月的随访中发生 291 例（0.44%）前列腺癌特异性死亡。21.2%的病例报告有阳性手术切缘，与 pT2 肿瘤相比，pT3a 肿瘤（44%比 18%，p<0.001）和高级别肿瘤（28%比 18%，p<0.001）更常见。对于那些患有前列腺癌特定死亡率高危（高级别 pT3a）的患者，7 年疾病特异性生存率为阴性手术切缘组为 97.6%，阳性手术切缘组为 92.4%。未调整的前列腺癌特异性死亡率风险增加 2.6 倍（HR 2.55，95%CI 2.02-3.21）。多变量分析显示，阳性手术切缘仍然是前列腺癌特异性死亡率的独立预测因素（HR 1.70，95%CI 1.32-2.18）。
这些数据表明，阳性手术切缘在前列腺癌特异性死亡率中具有独立作用。这些发现支持在可能的情况下，优化手术技术以获得阴性手术切缘的良好肿瘤学手术结果的重要性。
