Warner Jonathan N, Nunez Rafael N, Mmeje Chinedu O, Colby Thomas V, Ferrigni Robert G, Humphreys Mitchell R, Andrews Paul E, Castle Erik P
Department of Urology, Mayo Clinic, Phoenix, Arizona 85054, USA.
Can J Urol. 2011 Dec;18(6):6043-9.
We evaluate the impact of margin length, location, and pathologic stage on biochemical recurrence (BCR) after robot assisted radical prostatectomy (RARP) at 37 months of follow up.
A total of 1420 patients underwent a robot assisted radical prostatectomy between March 2004 and May 2010. Patients who received adjuvant therapy, those who never achieved an undetectable prostate-specific antigen (PSA), and those who had less than 18 months of follow up were excluded. Patients were then divided and evaluated based on margin status.
In total, 419 patients were included in the analysis. Eighty-three had a positive surgical margin (PSM) (19.8%), 336 had a negative surgical margin (NSM) (80.2%). The overall mean follow up was 37 months. On multivariate analysis the Gleason sum and PSM were independent predictors of BCR. Margin length and location had no significant difference on the rate of BCR. Patients with a PSM and pT2 disease had an increased rate of BCR compared to pT2 and NSM. The relative risk of BCR was 2.03 and 3.21 for patients who have a PSM versus a NSM, overall and in those with pT2 disease respectively. No different BCR is seen in pT2 PSM versus ≥ pT3 NSM; or ≥ pT3 PSM versus NSM.
With 37 months follow up; positive surgical margin and postoperative Gleason sum impact the rate of BCR. Location and length of the PSM do not appear to have an impact on BCR. There was an increased risk of BCR with PSM, especially in pT2 disease.
我们评估了在37个月的随访期内，切缘长度、位置及病理分期对机器人辅助根治性前列腺切除术（RARP）后生化复发（BCR）的影响。
2004年3月至2010年5月期间，共有1420例患者接受了机器人辅助根治性前列腺切除术。排除接受辅助治疗的患者、前列腺特异性抗原（PSA）从未降至不可检测水平的患者以及随访时间少于18个月的患者。然后根据切缘状态对患者进行分组和评估。
总计419例患者纳入分析。83例患者手术切缘阳性（PSM）（19.8%），336例患者手术切缘阴性（NSM）（80.2%）。总体平均随访时间为37个月。多因素分析显示，Gleason评分总和及PSM是BCR的独立预测因素。切缘长度和位置对BCR发生率无显著差异。与pT2及NSM患者相比，PSM及pT2疾病患者的BCR发生率更高。PSM患者与NSM患者相比，总体及pT2疾病患者BCR的相对风险分别为2.03和3.21。pT2 PSM与≥pT3 NSM患者之间；或≥pT3 PSM与NSM患者之间，未见BCR有差异。
随访37个月；手术切缘阳性及术后Gleason评分总和影响BCR发生率。PSM的位置和长度似乎对BCR无影响。PSM会增加BCR风险，尤其是在pT2疾病中。
