Department of Pathology, School of Medicine, University of Campinas-Unicamp, Brazil.
Int Braz J Urol. 2012 Mar-Apr;38(2):175-84. doi: 10.1590/s1677-55382012000200005.
The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification.
A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors.
Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis.
Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant predictors of shorter time to biochemical progression following radical prostatectomy.
在大多数研究中，前列腺外延伸和阳性手术切缘与根治性前列腺切除术后生化复发相关。我们使用一种简单的定量方法研究了局灶性和弥漫性前列腺外延伸以及阳性手术切缘对生化进展的影响。
对 175 例 T1c 期和 185 例临床 T2 期患者的 360 例前列腺进行了分步切片和完全处理。将前列腺外延伸分为 2 组：从膀胱颈或顶点到 1 个象限或切片（第 1 组，局灶性）和超过 1 个象限或切片（第 2 组，弥漫性）；阳性手术切缘至 2 个象限或切片（第 1 组，局灶性）和超过 2 个象限或切片（第 2 组，弥漫性）。采用Kaplan-Meier 乘积限法分析生化复发时间，采用单变量和多变量 Cox 逐步逻辑回归模型确定显著预测因素。
在 360 例患者中，有 129 例（35.8%）存在前列腺外延伸，其中 39 例（30.2%）位于第 1 组，90 例（69.8%）位于第 2 组。单变量分析但不是多变量分析显示，表现为弥漫性前列腺外延伸（第 2 组）的患者在较短的时间内发生生化复发的风险显著增加。在 360 例患者中，有 160 例（44.4%）存在阳性手术切缘，其中 81 例（50.6%）位于第 1 组，79 例（49.4%）位于第 2 组。在单变量和多变量分析中，弥漫性阳性手术切缘（第 2 组）的患者风险显著增加。在单变量和多变量分析中，弥漫性阳性手术切缘是生化进展时间较短的最强预测因素，也是多变量分析中的独立预测因素。
在单变量分析中，弥漫性前列腺外延伸和在单变量和多变量分析中阳性手术切缘都是根治性前列腺切除术后生化进展时间较短的显著预测因素。
