Maxeiner Andreas, Magheli Ahmed, Jöhrens Korinna, Kilic Ergin, Braun Tom Lukas, Kempkensteffen Carsten, Hinz Stefan, Stephan Carsten, Miller Kurt, Busch Jonas
Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
BJU Int. 2016 Nov;118(5):750-757. doi: 10.1111/bju.13451. Epub 2016 Mar 19.
To verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP).
The detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan-Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed.
Central pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08-2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08-2.72; P = 0.022).
The impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.
根据国际泌尿病理学会（ISUP）2009年共识会议更新的切缘标准，通过中心病理复查，回顾性验证根治性前列腺切除术（RP）患者的切缘状态，并分析阳性手术切缘（PSM）的位置和特征。
对1999年至2007年间接受腹腔镜RP（LRP）的441例患者的详细PSM特征进行中心复查，内容包括位置、数量、PSM处的Gleason评分和肿瘤宽度。研究PSM的预测因素以及几种PSM特征对临床结局的影响。使用卡方检验比较患者特征。使用对数秩检验分析无复发生存（RFS）率的差异，并以Kaplan-Meier生存曲线表示。进行单变量和多变量Cox回归分析以预测RFS。
根据ISUP 2009更新的PSM定义进行中心病理复查，导致大量有PSM的患者（n = 113，26.6%）重新分类为R0。确定了几种具有较高生化复发（BCR）风险的PSM特征，它们是RFS的最强独立预测因素：病理分期；Gleason评分；以及多个PSM的存在（风险比[HR] 1.78；95%置信区间[CI] 1.08 - 2.96；P = 0.025）。用PSM宽度类别替代PSM位置的进一步分析表明，PSM>3 mm是RFS的独立预测因素（HR 1.72；95% CI 1.08 - 2.72；P = 0.022）。
LRP治疗前列腺癌后PSM的影响仍不明确。本队列接受LRP的患者的PSM具有不同特征，并赋予不同的BCR风险。需要更好地了解PSM特征并进行仔细的标准化病理评估，以便就LRP后的预后和辅助治疗向患者提供充分的咨询。
