Vrang Marie-Louise, Røder Martin Andreas, Vainer Ben, Christensen Ib Jarle, Gruschy Lisa, Brasso Klaus, Iversen Peter
Urology Research Unit, Department of Urology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Scand J Urol Nephrol. 2012 Jun;46(3):172-9. doi: 10.3109/00365599.2011.644860. Epub 2012 Feb 9.
This study aimed to investigate the impact of positive surgical margins (PSMs), stratified by location and extension, on biochemical outcome after radical retropubic prostatectomy (RRP).
The study included data from 605 consecutive patients treated with RRP for localized prostate cancer. Patients with node-positive disease were excluded. Biochemical recurrence-free survival was calculated using the Kaplan-Meier method. Univariate and multivariate analysis was used to assess risk factors.
The overall PSM rate was 35.4%. Eighty-three per cent (82.7%) of these had a single PSM, whereas 17.3% of patients had two or more PSMs. Apical PSMs were present in 42.5% and non-apical in 57.5%. The presence of any PSM had a significant impact on the risk of biochemical recurrence (BR) [hazard ratio (HR) = 3.3, p < 0.0001]. Compared with margin-negative patients, both apical and non-apical PSMs increased the risk of BR (HR = 2.1 and 4.2, p = 0.02 and p < 0.0001, respectively). The number of PSMs also influenced the risk of BR (one PSM: HR = 2.8, p < 0.0001, vs two or more PSMs: HR = 5.5, p < 0.0001). In multivariate analysis, pT category, PSA and prostatectomy Gleason score independently increased the risk of BR. In an exploratory multivariate analysis of pT2 tumours, the impact of apical PSMs on biochemical recurrence-free survival (BRFS) was not statistically significant, although with an HR of 2.1. Non-apical PSM was associated with a significantly increased risk of BR (HR = 3.4, p = 0.01). Number of PSMs did not influence the risk of BR in multivariate analysis.
The presence of PSMs after RRP is associated with a higher risk of BR. Multiple and non-apical PSMs are associated with a significantly higher risk of BR compared to single and apical PSMs.
本研究旨在探讨切缘阳性（PSM），按位置和范围分层，对耻骨后根治性前列腺切除术（RRP）后生化结果的影响。
该研究纳入了605例因局限性前列腺癌接受RRP治疗的连续患者的数据。排除有淋巴结转移阳性疾病的患者。采用Kaplan-Meier法计算无生化复发生存率。单因素和多因素分析用于评估危险因素。
总体PSM率为35.4%。其中83%（82.7%）有单个PSM，而17.3%的患者有两个或更多PSM。尖部PSM占42.5%，非尖部占57.5%。任何PSM的存在对生化复发（BR）风险有显著影响[风险比（HR）=3.3，p<0.0001]。与切缘阴性患者相比，尖部和非尖部PSM均增加了BR风险（HR分别为2.1和4.2，p分别为0.02和p<0.0001）。PSM的数量也影响BR风险（单个PSM：HR=2.8，p<0.0001，vs两个或更多PSM：HR=5.5，p<0.0001）。在多因素分析中，pT分期、前列腺特异性抗原（PSA）和前列腺切除术后Gleason评分独立增加BR风险。在对pT2肿瘤的探索性多因素分析中，尖部PSM对无生化复发生存率（BRFS）的影响虽HR为2.1，但无统计学意义。非尖部PSM与BR风险显著增加相关（HR=3.4，p=0.01）。在多因素分析中，PSM的数量不影响BR风险。
RRP后PSM的存在与较高的BR风险相关。与单个和尖部PSM相比，多个和非尖部PSM与显著更高的BR风险相关。
