Department of Urology, Athens University Medical School, LAIKO Hospital, 17 Agiou Thoma str, 11527 Athens, Greece.
Int Urol Nephrol. 2011 Sep;43(3):715-20. doi: 10.1007/s11255-010-9859-8. Epub 2010 Oct 30.
There is a discrepancy in reporting biochemical recurrence (BCR) rates in patients with positive surgical margins (PSM) after a radical prostatectomy (RP), ranging between 19 and 61%. Our aim was to identify the parameters that contribute to the absence of BCR in patients with PSM by performing a multivariate analysis.
From a cohort of 1163 patients who underwent open RP over a 6-year period, 69 exhibited PSM. Of the 69, 39 had and 30 did not have a BCR during a 3-year follow-up. The analysis comprised preoperative and postoperative PSA serum levels, age, weight of the prostate, pathology tumor grade, time of BCR, number and location of PSM.
In the univariate analysis, the weight of prostate was statistically significantly associated with the odds of BCR (P = 0.027, 95% CI 1.00-1.06). Bladder neck and lateral locations of PSM were negatively associated with BCR, without exhibiting statistical significance in the multivariate analysis. Age was negatively associated with the odds of BCR whereas preoperative PSA, stage and Gleason score were positively associated, but did not exhibit statistical significance in both uni- and multivariate analysis.
A low weight prostate, younger age, bladder neck and lateral location of PSM seem to protect patients from having a BCR. On the other hand, preoperative PSA, stage of the disease and Gleason score do contribute to the occurrence of BCR. Lack of statistical significance in the above results could be attributed to the small number of patients due to the study's low PSM rate.
在接受根治性前列腺切除术（RP）后存在阳性切缘（PSM）的患者中，报告生化复发（BCR）率存在差异，范围在 19%至 61%之间。我们的目的是通过进行多变量分析，确定导致 PSM 患者缺乏 BCR 的参数。
在 6 年期间接受开放式 RP 的 1163 名患者中，有 69 例存在 PSM。在这 69 例中，有 39 例和 30 例在 3 年随访期间没有发生 BCR。分析包括术前和术后 PSA 血清水平、年龄、前列腺重量、病理肿瘤分级、BCR 时间、PSM 的数量和位置。
在单变量分析中，前列腺重量与 BCR 的可能性呈统计学显著相关（P = 0.027，95%CI 1.00-1.06）。膀胱颈和侧面位置的 PSM 与 BCR 呈负相关，但在多变量分析中无统计学意义。年龄与 BCR 的可能性呈负相关，而术前 PSA、疾病分期和 Gleason 评分与 BCR 的可能性呈正相关，但在单变量和多变量分析中均无统计学意义。
前列腺重量低、年龄较小、PSM 位于膀胱颈和侧面似乎可保护患者免受 BCR 的影响。另一方面，术前 PSA、疾病分期和 Gleason 评分与 BCR 的发生有关。上述结果缺乏统计学意义可能归因于由于研究中 PSM 发生率低，导致患者数量较少。
