Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA.
Hum Pathol. 2012 Feb;43(2):254-60. doi: 10.1016/j.humpath.2011.04.029. Epub 2011 Aug 4.
Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3 radical prostatectomy modalities. Preoperative prostate-specific antigen density and number of positive surgical margin foci were the only independent predictors of biochemical recurrence.
详细比较开放经耻骨后前列腺切除术、腹腔镜前列腺切除术和机器人辅助腹腔镜前列腺切除术之间阳性切缘差异的研究较少。我们中心对 2007 年所有阳性切缘前列腺切除术的回顾性研究共发现 99 例，其中 6 例（5%）为重新解释的阴性切缘病例。因此，共有 93 例被纳入研究，其中包括 37 例经耻骨后前列腺切除术、19 例腹腔镜前列腺切除术和 37 例机器人辅助腹腔镜前列腺切除术。评估了阳性切缘特征与临床病理参数和生化复发的关系。在所有组中，最常见的阳性切缘部位是尖端/远端三分之一（62%经耻骨后前列腺切除术、79%腹腔镜前列腺切除术、60%机器人辅助前列腺切除术）。阳性切缘部位的总线性长度与术前前列腺特异性抗原、术前前列腺特异性抗原密度、pT 分期和肿瘤体积显著相关（P≤0.001）。我们发现 3 组之间在总线性长度、阳性切缘部位的数量、侧别或阳性切缘部位的位置方面无显著差异。3 组之间的生化复发率也相似。单因素分析显示，生化复发与术前前列腺特异性抗原值、术前前列腺特异性抗原密度、Gleason 评分、阳性切缘部位数量和阳性切缘总线性长度显著相关（P≤0.02）。只有术前前列腺特异性抗原密度和阳性切缘部位数量具有统计学意义（P≤0.03），是生化复发的独立预测因素。我们发现 3 种前列腺根治术方式之间阳性切缘特征或生化复发无显著差异。术前前列腺特异性抗原密度和阳性切缘部位数量是生化复发的唯一独立预测因素。
