Gacci Mauro, Simonato Alchiede, Lanciotti Michele, Ennas Marco, Varca Virginia, Maffezzini Massimo, Imbimbo Ciro, Gontero Paolo, Schiavina Riccardo, Carini Marco, Martorana Giuseppe, Nicita Giulio, Mirone Vincenzo, Carmignani Giorgio
Department of Urology, University of Florence, Italy.
Urol Int. 2013;91(1):62-8. doi: 10.1159/000346748. Epub 2013 May 28.
To analyze positive surgical margins (PSM) after radical prostatectomy (RP) in the overall population and in patients previously treated with transurethral resection of the prostate (TURP).
2,408 patients treated with RP for clinically localized prostate cancer (PCa) were consecutively enrolled in 135 departments. We correlated PSM rates and all preoperative, surgical and pathological features. We stratified the site of PSM as unique or multifocal. Moreover, we analyzed differences between 75 patients who had undergone previous TURP and the remaining 2,333 patients.
In the entire study population, we identified 702 patients with PSM (29%). Using univariate analysis, we reported a significant correlation between overall PSM and prostate-specific antigen (PSA), stage cT, biopsy Gleason score, number of biopsy cores, number of positive cores, percentage of positive cores and nerve-sparing approach. PSM proved to be strongly dependent on pT in particular in patients with pT2 PCa. When we compared the data from 75 patients previously treated with TURP and those from 2,333 without previous prostatic surgery, a statistically significant difference in margin localization was found. Moreover, we analyzed the 75 patients mentioned above, stratified in incidental PCa diagnosed at TURP or PCa detected with prostate biopsy for PSA rising during the post-TURP follow-up: no statistical differences were found between the 2 groups regarding margin status, even if PSM were more frequent in incidental PCa with no significance deriving from the stratification for PSM location at the apex or base.
Men treated with TURP before RP presented an overall incidence of PSM similar to those without previous TURP, but with a higher risk of PSM at the bladder neck and a lower risk of PSM at the prostatic apex.
分析在总体人群以及既往接受经尿道前列腺切除术（TURP）的患者中，根治性前列腺切除术（RP）后切缘阳性（PSM）的情况。
连续纳入135个科室中因临床局限性前列腺癌（PCa）接受RP治疗的2408例患者。我们将PSM发生率与所有术前、手术及病理特征进行关联分析。我们将PSM的部位分为单灶性或多灶性。此外，我们分析了75例既往接受过TURP的患者与其余2333例患者之间的差异。
在整个研究人群中，我们确定了702例PSM患者（29%）。采用单因素分析，我们发现总体PSM与前列腺特异性抗原（PSA）、cT分期、活检Gleason评分、活检针数、阳性针数、阳性针数百分比及保留神经的手术方式之间存在显著相关性。PSM尤其在pT2期PCa患者中强烈依赖于pT分期。当我们比较75例既往接受过TURP的患者与2333例未接受过前列腺手术的患者的数据时，发现切缘定位存在统计学显著差异。此外，我们分析了上述75例患者，将其分为TURP时偶然诊断的PCa或TURP术后随访期间因PSA升高经前列腺活检检测出的PCa：两组在切缘状态方面未发现统计学差异，即使PSM在偶然PCa中更常见，但在尖部或基底部PSM定位分层方面无显著差异。
RP术前接受TURP治疗的男性患者PSM的总体发生率与未接受过TURP的患者相似，但膀胱颈切缘阳性风险较高，前列腺尖部切缘阳性风险较低。
