Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School and Genoa Biotechnology, Sao Paulo, Brazil.
Genoa Biotechnology, Sao Paulo, Brazil.
Int Braz J Urol. 2014 Mar-Apr;40(2):146-53. doi: 10.1590/S1677-5538.IBJU.2014.02.03.
Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy.
Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence.
236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7.
Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.
最近发表的少数研究表明，根治性前列腺切除术标本中阳性手术切缘的组织学细节与术后结果有关。我们的目的是评估手术切缘状态、阳性切缘的范围和 Gleason 评分、以及前列腺外延伸的范围是否可预测根治性前列腺切除术后的生化复发。
分析了 365 例根治性前列腺切除术标本。记录了阳性手术切缘的长度和前列腺外延伸以及切缘的 Gleason 评分。统计分析检查了这些变量对生化复发的预测价值。
236 例患者为 pT2R0 期，58 例为 pT2R1 期，25 例为 pT3R0 期，46 例为 pT3R1 期。生化复发分别发生在 pT2R0、pT2R1、pT3R0 和 pT3R1 患者的 11%、31%、20%和 45.7%。在平均随访 35.9 个月的单因素分析中，阳性手术切缘的范围和阳性手术切缘的 Gleason 评分与生化复发无关。在多因素分析中，只有手术切缘状态和整体 Gleason 评分与生化复发相关，阳性手术切缘的复发风险为 3.1，Gleason 评分>7 的复发风险为 3.8。
阳性手术切缘和整体 Gleason 评分是根治性前列腺切除术后生化复发的重要危险因素，与手术切缘的范围、前列腺外延伸的范围或阳性手术切缘或前列腺外组织的局部 Gleason 评分无关。pT2R1 疾病的表现与 pT3R0 相同，应采用类似的治疗方法。
