Hsu Mark, Chang Steven L, Ferrari Michelle, Nolley Rosalie, Presti Joseph C, Brooks James D
Department of Urology, Stanford University Medical Center, Stanford, California, USA.
Int J Urol. 2011 Apr;18(4):272-9. doi: 10.1111/j.1442-2042.2011.02729.x. Epub 2011 Feb 22.
Positive surgical margins (PSM) have been associated with biochemical recurrence (BCR) after radical prostatectomy, but the significance of PSM length and location are debated. We assessed the impact of PSM lengths at specific locations for BCR in an open radical prostatectomy series.
Detailed clinical and pathological data were collected from 117 post-prostatectomy patients with PSM from 1984 to 2004 at our institution. PSM locations were classified as apex, mid-gland, base, bladder neck, and anterior fibromuscular region with lengths measured at each site. Aggregate PSM length was obtained by summing lengths of all PSM areas in contact with the inked surface. BCR was defined as serum prostate specific antigen level 0.2 ng/mL or greater. Cox proportional hazards regression analyses of PSM lengths were conducted either as a continuous or categorical variable relative to location as a predictor of BCR.
Multivariate analyses demonstrated that as a continuous variable, PSM length at the anterior fibromuscular region (Hazard ratio [HR] = 1.17; P = 0.027) and bladder neck (HR = 1.29; P = 0.046) were significant predictors for BCR. As a categorical variable, PSM length ≥ 2 mm at the anterior fibromuscular area was significant for BCR (HR = 3.02; P = 0.036). Increasing Gleason grade and positive lymph node status were also found to be significant independent predictors for BCR.
PSM length at the anterior fibromuscular region (continuous and categorical) and the bladder neck (continuous) was significantly associated with BCR. Site-specific PSM length, along with Gleason grade and lymph node status, can be predictive of BCR and assist in risk stratification of patients with PSM following radical prostatectomy.
切缘阳性（PSM）与根治性前列腺切除术后生化复发（BCR）相关，但PSM长度和位置的意义仍存在争议。我们在开放性根治性前列腺切除术系列中评估了特定位置的PSM长度对BCR的影响。
收集了1984年至2004年在我院接受前列腺切除术后出现PSM的117例患者的详细临床和病理数据。PSM位置分为尖部、腺体中部、基部、膀胱颈部和前纤维肌区域，并测量每个部位的长度。总PSM长度通过将所有与墨染表面接触的PSM区域长度相加获得。BCR定义为血清前列腺特异性抗原水平≥0.2 ng/mL。对PSM长度进行Cox比例风险回归分析，将其作为相对于位置的连续或分类变量，以预测BCR。
多变量分析表明，作为连续变量，前纤维肌区域的PSM长度（风险比[HR]=1.17；P=0.027）和膀胱颈部的PSM长度（HR=1.29；P=0.046）是BCR的显著预测因素。作为分类变量，前纤维肌区域PSM长度≥2 mm对BCR具有显著意义（HR=3.02；P=0.036）。Gleason分级增加和淋巴结阳性状态也被发现是BCR的显著独立预测因素。
前纤维肌区域（连续和分类）和膀胱颈部（连续）的PSM长度与BCR显著相关。特定部位的PSM长度，连同Gleason分级和淋巴结状态，可预测BCR，并有助于对根治性前列腺切除术后有PSM的患者进行风险分层。
