Ploussard Guillaume, Drouin Sarah J, Rode Julie, Allory Yves, Vordos Dimitri, Hoznek Andras, Abbou Claude-Clément, de la Taille Alexandre, Salomon Laurent
Department of Urology and Pathology, Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France,
World J Urol. 2014 Dec;32(6):1393-400. doi: 10.1007/s00345-014-1243-3. Epub 2014 Jan 21.
To study the prognostic value of extent, number, and location of positive surgical margins (PSM).
A total of 1,504 consecutive adjuvant treatment naive and node-negative radical prostatectomy men were included in a prospective database including extent, number, and location of PSM. Mean follow-up was 33 months. Endpoint was biochemical progression-free (bPFS) survival. The impact of margin status and characteristics was assessed in time-dependent analyses using Cox regression and Kaplan-Meier methods.
PSM was reported in 26.7 % of patients. The predominant PSM locations were apex and posterior locations. Median PSM length was 4.0 mm. The 2-year bPFS was 73.7 % in PSM patients as compared to 93.0 % in NSM patients (p < 0.001). The rate and extent of PSM increased significantly with pathologic stage (p < 0.001). The extent of PSM length was linearly correlated with bPFS (p = 0.017, coefficient: -0.122). In univariable analysis, extent and number of PSM were significantly linked to outcomes. None of PSM subclassifications significantly influenced the bPFS rates in the subgroup of pT2 disease patients. Conversely, stratification by PSM location (apex vs. other locations, p = 0.008), by PSM number (p = 0.006), and by PSM length (p < 0.001) showed significant differences in pT3-4 cancer patients. In that subgroup, PSM length also added to bPFS prediction using PSM status only in multivariable models (p = 0.005).
PSM subclassifications do not improve the biochemical recurrence prediction in organ-confined disease. In non-organ-confined disease, PSM length (≥3 mm), multifocality (≥3 sites), and apical location are significantly linked to poorer outcomes and could justify a more aggressive adjuvant treatment approach.
研究阳性手术切缘（PSM）的范围、数量及位置的预后价值。
1504例接受初次辅助治疗且淋巴结阴性的前列腺癌根治术患者被纳入前瞻性数据库，该数据库记录了PSM的范围、数量及位置。平均随访时间为33个月。终点指标为无生化进展（bPFS）生存期。采用Cox回归和Kaplan-Meier方法，在时间依赖性分析中评估切缘状态和特征的影响。
26.7%的患者报告有PSM。PSM的主要位置是尖部和后部。PSM的中位长度为4.0毫米。PSM患者的2年bPFS为73.7%，而无PSM患者为93.0%（p<0.001）。PSM的发生率和范围随病理分期显著增加（p<0.001）。PSM长度范围与bPFS呈线性相关（p = 0.017，系数：-0.122）。单因素分析中，PSM的范围和数量与预后显著相关。在pT2期疾病患者亚组中，PSM的任何亚分类均未显著影响bPFS率。相反，按PSM位置（尖部与其他位置，p = 0.008）、PSM数量（p = 0.006）和PSM长度（p<0.001）分层显示，pT3-4期癌症患者存在显著差异。在该亚组中，仅在多变量模型中，PSM长度也增加了仅使用PSM状态对bPFS的预测价值（p = 0.005）。
PSM亚分类不能改善局限期疾病的生化复发预测。在非局限期疾病中，PSM长度（≥3毫米）、多灶性（≥3个部位）和尖部位置与较差的预后显著相关，可能需要采取更积极的辅助治疗方法。
