Tanimoto Ryuta, Fashola Yomi, Scotland Kymora B, Calvaresi Anne E, Gomella Leonard G, Trabulsi Edouard J, Lallas Costas D
Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut St. Suite 1112, Philadelphia, PA, 19107, USA.
BMC Urol. 2015 Apr 8;15:27. doi: 10.1186/s12894-015-0024-7.
Radical prostatectomy is a standard surgical treatment of clinically localized prostate cancer. Margin status has been found to be an independent predictor of biochemical recurrence (BCR) after open radical prostatectomy in several large series but this is still controversy in Robotic Assisted Radical Prostatectomy (RARP) series. We therefore wanted to investigate the prognostic significance of positive surgical margin (PSM) and other pathological factors on BCR in patients treated with RARP by a single surgeon.
Prospectively collected data of 439 patients treated with RARP between October 2005 and June 2013 by a single surgeon at a single institution were analyzed. BCR was defined as follow-up PSA level > 0.2 ng/ml on two separate occasions or patients who had to undergo salvage therapy. Kaplan Meier curves and Log Rank test were used to compare the risk of BCR. Univariate and Multivariate Cox Regression analyses were performed to determine the prognostic impact of age, BMI, prostate weight, PSA prior to surgery, pathological T-stage, pathological Gleason sum, PSM and operative period.
In this study period, 34 out of 439 had BCR, giving an overall BCR rate of 7.7% for this cohort. Overall 2- and 3-year BCR-free survival rates were 93% and 88%, respectively. Patients with a PSM had a 2-year BCR free survival of 88% compared to 94% in those with negative margins (p < .0001). On the multivariate analysis, PSM as well as pathological Gleason sum > = 8, PSA, pathological stage and operative period were significantly associated with BCR.
In our case series of RARP performed by a single surgeon, PSM as well as pathological Gleason sum, PSA, pathological stage and early operative period for this surgeon were the independent predictors of BCR.
根治性前列腺切除术是临床局限性前列腺癌的标准外科治疗方法。在多个大型系列研究中，切缘状态已被发现是开放性根治性前列腺切除术后生化复发（BCR）的独立预测因素，但在机器人辅助根治性前列腺切除术（RARP）系列中仍存在争议。因此，我们想研究单一外科医生进行RARP治疗的患者中，手术切缘阳性（PSM）及其他病理因素对BCR的预后意义。
分析了2005年10月至2013年6月期间在单一机构由单一外科医生进行RARP治疗的439例患者的前瞻性收集数据。BCR定义为两次独立随访时PSA水平>0.2 ng/ml或必须接受挽救性治疗的患者。采用Kaplan Meier曲线和Log Rank检验比较BCR风险。进行单因素和多因素Cox回归分析，以确定年龄、BMI、前列腺重量、术前PSA、病理T分期、病理Gleason评分、PSM和手术时间的预后影响。
在本研究期间，439例患者中有34例发生BCR，该队列的总体BCR率为7.7%。总体2年和3年无BCR生存率分别为93%和88%。PSM患者的2年无BCR生存率为88%，而切缘阴性患者为94%（p<0.0001）。多因素分析显示，PSM以及病理Gleason评分>=8、PSA、病理分期和手术时间与BCR显著相关。
在我们由单一外科医生进行的RARP病例系列中，PSM以及病理Gleason评分、PSA、病理分期和该外科医生的早期手术时间是BCR的独立预测因素。
