Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA.
Department of Urology, University of California, San Diego, CA, USA.
BJU Int. 2018 Oct;122(4):592-598. doi: 10.1111/bju.14178. Epub 2018 Mar 25.
To evaluate biochemical recurrence (BCR) patterns amongst men undergoing radical prostatectomy (RP) with specimens having negative (NSM), positive (PSM), and close surgical margins (CSM) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort, as PSM after RP are a significant predictor of biochemical failure and possible disease progression, with CSM representing a diagnostic challenge for surgeons.
Men undergoing RP between 1988 and 2015 with known final pathological margin status were evaluated. The cohort was divided into three groups based on margin status; NSM, PSM, and CSM. CSM were defined by distance of tumour ≤1 mm from the surgical margin. BCR was defined as a prostate-specific antigen (PSA) level of >0.2 ng/mL, two values at 0.2 ng/mL, or secondary treatment for an elevated PSA level. Predictors of BCR, metastases, and mortality were analysed using Cox proportional hazard models.
Of 5515 men in the SEARCH database, 4337 (79%) men met criteria for inclusion in the analysis. Of these, 2063 (48%) had NSM, 1902 (44%) had PSM, and 372 (8%) had CSM. On multivariable analysis, relative to NSM, men with CSM had a higher risk of BCR (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.25-1.82; P < 0.001) but a decreased risk of BCR when compared to those men with PSM (HR 2.09, 95% CI 1.86-2.36; P < 0.001). Metastases, prostate cancer-specific mortality and all-cause mortality did not differ based on margin status alone.
Management of men with CSM is a diagnostic challenge, with a disease course that is not entirely benign. The evaluation of other known risk factors probably provides greater prognostic value for these men and may ultimately better select those who may benefit from adjuvant therapy.
评估来自共享平等获取区域癌症医院（SEARCH）队列中接受根治性前列腺切除术（RP）的男性的生化复发（BCR）模式，这些男性的标本有阴性切缘（NSM）、阳性切缘（PSM）和接近手术切缘（CSM）。因为 RP 后的 PSM 是生化失败和可能疾病进展的重要预测因子，而 CSM 则代表了外科医生的诊断挑战。
评估了 1988 年至 2015 年间接受 RP 且已知最终病理切缘状态的男性。该队列根据切缘状态分为三组：NSM、PSM 和 CSM。CSM 定义为肿瘤距离手术切缘≤1mm。BCR 定义为前列腺特异性抗原（PSA）水平>0.2ng/mL、两次值为 0.2ng/mL 或因 PSA 水平升高而进行二次治疗。使用 Cox 比例风险模型分析 BCR、转移和死亡的预测因素。
在 SEARCH 数据库中，有 5515 名男性符合纳入分析的标准，其中 4337 名（79%）男性符合纳入分析的标准。在这些男性中，2063 名（48%）有 NSM，1902 名（44%）有 PSM，372 名（8%）有 CSM。多变量分析显示，与 NSM 相比，CSM 男性发生 BCR 的风险更高（危险比 [HR] 1.51，95%置信区间 [CI] 1.25-1.82；P<0.001），但与 PSM 男性相比，发生 BCR 的风险降低（HR 2.09，95% CI 1.86-2.36；P<0.001）。仅根据切缘状态，转移、前列腺癌特异性死亡率和全因死亡率没有差异。
CSM 男性的管理是一个诊断挑战，其疾病过程并非完全良性。评估其他已知的风险因素可能为这些男性提供更大的预后价值，并最终更好地选择那些可能受益于辅助治疗的患者。
