Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, Florida, USA.
J Urol. 2011 Aug;186(2):511-6. doi: 10.1016/j.juro.2011.03.112. Epub 2011 Jun 15.
Positive surgical margins are an independent predictive factor for biochemical recurrence after radical prostatectomy. We analyzed the incidence of and associative factors for positive surgical margins in a multi-institutional series of 8,418 robotic assisted radical prostatectomies.
We analyzed the records of 8,418 patients who underwent robotic assisted radical prostatectomy at 7 institutions. Of the patients 323 had missing data on margin status. Positive surgical margins were categorized into 4 groups, including apex, bladder neck, posterolateral and multifocal. The records of 6,169 patients were available for multivariate analysis. The variables entered into the logistic regression models were age, body mass index, preoperative prostate specific antigen, biopsy Gleason score, prostate weight and pathological stage. A second model was built to identify predictive factors for positive surgical margins in the subset of patients with organ confined disease (pT2).
The overall positive surgical margin rate was 15.7% (1,272 of 8,095 patients). The positive surgical margin rate for pT2 and pT3 disease was 9.45% and 37.2%, respectively. On multivariate analysis pathological stage (pT2 vs pT3 OR 4.588, p<0.001) and preoperative prostate specific antigen (4 or less vs greater than 10 ng/ml OR 2.918, p<0.001) were the most important independent predictive factors for positive surgical margins after robotic assisted radical prostatectomy. Increasing prostate weight was associated with a lower risk of positive surgical margins after robotic assisted radical prostatectomy (OR 0.984, p<0.001) and a higher body mass index was associated with a higher risk of positive surgical margins (OR 1.032, p<0.001). For organ confined disease preoperative prostate specific antigen was the most important factor that independently correlated with positive surgical margins (4 or less vs greater than 10 ng/ml OR 3.8, p<0.001).
The prostatic apex followed by a posterolateral site was the most common location of positive surgical margins after robotic assisted radical prostatectomy. Factors that correlated with cancer aggressiveness, such as pathological stage and preoperative prostate specific antigen, were the most important factors independently associated with an increased risk of positive surgical margins after robotic assisted radical prostatectomy.
阳性切缘是根治性前列腺切除术后生化复发的独立预测因素。我们分析了 7 家机构 8418 例机器人辅助根治性前列腺切除术的阳性切缘发生率及相关因素。
我们分析了 7 家机构 8418 例机器人辅助根治性前列腺切除术患者的病历资料，其中 323 例患者的切缘状态数据缺失。阳性切缘分为 4 组，包括尖部、膀胱颈部、后外侧和多灶性。6169 例患者的病历资料可用于多变量分析。纳入逻辑回归模型的变量包括年龄、体重指数、术前前列腺特异性抗原、活检 Gleason 评分、前列腺重量和病理分期。建立第二个模型以确定局限于器官疾病（pT2）患者中阳性切缘的预测因素。
总体阳性切缘率为 15.7%（8095 例患者中有 1272 例）。pT2 和 pT3 疾病的阳性切缘率分别为 9.45%和 37.2%。多变量分析显示，病理分期（pT2 与 pT3，OR 4.588，p<0.001）和术前前列腺特异性抗原（4 或以下与大于 10ng/ml，OR 2.918，p<0.001）是机器人辅助根治性前列腺切除术后阳性切缘的最重要独立预测因素。前列腺重量增加与机器人辅助根治性前列腺切除术后阳性切缘的风险降低相关（OR 0.984，p<0.001），而体重指数增加与阳性切缘的风险增加相关（OR 1.032，p<0.001）。对于局限于器官疾病，术前前列腺特异性抗原是与阳性切缘独立相关的最重要因素（4 或以下与大于 10ng/ml，OR 3.8，p<0.001）。
机器人辅助根治性前列腺切除术后，阳性切缘最常见于前列腺尖部和后外侧。与癌症侵袭性相关的因素，如病理分期和术前前列腺特异性抗原，是与机器人辅助根治性前列腺切除术后阳性切缘风险增加相关的最重要的独立因素。
