Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Section of Urology, Veterans Affairs Medical Center, Augusta, GA, USA.
Prostate Cancer Prostatic Dis. 2016 Dec;19(4):423-428. doi: 10.1038/pcan.2016.45. Epub 2016 Oct 4.
Approximately 29-38% of all positive surgical margins (PSMs) at radical prostatectomy (RP) involve the apex. The prognostic significance of apical PSM remains unclear. We therefore compared the long-term oncologic outcomes of men with apical PSMs to those with negative PSMs, apical and other PSMs, and other PSMs at RP.
The SEARCH (Shared Equal Access Regional Cancer Hospital) database was used to identify 4031 men with prostate cancer (PCa) managed with RP with complete pathologic grade and stage data. Margin status was categorized as negative, apex only, or other positive. Multivariable Cox regression models adjusted for pathologic stage and grade were developed to test the relationship between margin status and biochemical recurrence (BCR), metastases and PCa death.
In the final cohort, 34.3% had PSMs, whereas 65.7% had negative margins. Univariable analysis showed that compared with negative margins, apex-only PSM was associated with BCR (hazard ratio (HR): 1.4 [1.1-1.8]), but not metastases or PCa death, whereas apex and other PSMs were associated with BCR (HR: 3.3 [2.8-4]) and metastases (HR: 1.8 [1.02-3.1]) but not PCa death. Nonapical PSMs were associated with BCR (HR: 2.7 [2.4-3.1]), metastases (1.7 [1.2-2.5)] and PCa death (1.8 [1.05-3]). On multivariable analysis, apex-only, apex and other, and nonapical PSMs were associated with BCR but margin status was not associated with metastases or PCa death.
In a large cohort of men undergoing RP, those with PSMs at the prostatic apex had lower BCR, metastases, or PCa death compared with those with PSMs at other locations. When adjusted for pathologic stage and grade, however, PSMs were associated with BCR but not long-term oncologic outcomes. These data confirm that men with apex-only PSMs may not be ideal candidates for adjuvant therapy after RP.
根治性前列腺切除术（RP）中约有 29-38%的阳性切缘（PSM）累及尖端。尖端 PSM 的预后意义尚不清楚。因此，我们比较了 RP 中尖端 PSM 与阴性 PSM、尖端和其他 PSM 以及其他 PSM 的长期肿瘤学结果。
使用 SEARCH（共享平等获取区域癌症医院）数据库确定了 4031 名接受 RP 治疗且具有完整病理分级和分期数据的前列腺癌（PCa）男性。切缘状态分为阴性、仅尖端或其他阳性。开发多变量 Cox 回归模型以测试切缘状态与生化复发（BCR）、转移和 PCa 死亡之间的关系。
在最终队列中，34.3%有 PSM，65.7%有阴性切缘。单变量分析表明，与阴性切缘相比，仅尖端 PSM 与 BCR 相关（危险比 (HR)：1.4 [1.1-1.8]），但与转移或 PCa 死亡无关，而尖端和其他 PSM 与 BCR（HR：3.3 [2.8-4]）和转移（HR：1.8 [1.02-3.1]）相关，但与 PCa 死亡无关。非尖端 PSM 与 BCR（HR：2.7 [2.4-3.1]）、转移（1.7 [1.2-2.5]）和 PCa 死亡（1.8 [1.05-3]）相关。多变量分析显示，仅尖端、尖端和其他、非尖端 PSM 与 BCR 相关，但切缘状态与转移或 PCa 死亡无关。
在接受 RP 的大量男性患者中，与位于其他部位的 PSM 相比，前列腺尖端有 PSM 的患者的 BCR、转移或 PCa 死亡较低。然而，在调整病理分期和分级后，PSM 与 BCR 相关，但与长期肿瘤学结果无关。这些数据证实，仅尖端 PSM 的男性可能不是 RP 后辅助治疗的理想人选。
