Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Clin Genitourin Cancer. 2019 Feb;17(1):e130-e139. doi: 10.1016/j.clgc.2018.09.024. Epub 2018 Oct 4.
The objective of this study was to investigate positive surgical margin (PSM) rates in patients with prostate cancer treated with radical prostatectomy (RP) and assess PSM impact on cancer-specific mortality (CSM).
Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015), we identified men who underwent RP with pathologic T2 or T3a stage. Annual trends of PSM rates were plotted. Subgroups focused on geographic regions, namely the North Central, Northeast, South, and West. Cumulative incidence plots depicted other-cause mortality-adjusted CSM rates. Multivariable competing risks regression models tested the relationship between PSM and CSM. Subgroup analyses focused on pathologic stage, Gleason score, and geographic region.
Of 153,329 patients treated with RP, 12.3% (n = 18,935) exhibited PSM. Overall, in pathologic T2 stage and pathologic T3a stage, PSM rates decreased during the study period from 18.7% to 9.7% (P < .001), 15.7% to 7.3% (P < .001), and 39.0% to 18.0% (P < .001), respectively. In subgroup analyses focusing on geographic regions, PSM rates universally decreased. However, the magnitude differed. In multivariable competing risks regression models, PSM rates were associated with higher CSM (hazard ratio, 1.45; P < .001). However, geographic regions failed to reach independent predictor status. Insufficient information about PSM focality, length, and associated Gleason score represent important limitations.
It is encouraging that PSM rates decreased during the study period, even after stratification according to tumor stage. PSM decreased within the 4 examined geographic regions. However, the rate of decrease varied in magnitude, but geographic regions did not represent an independent predictor of PSM.
本研究旨在探讨接受根治性前列腺切除术（RP）治疗的前列腺癌患者中阳性切缘（PSM）的发生率，并评估 PSM 对癌症特异性死亡率（CSM）的影响。
我们在监测、流行病学和最终结果（SEER）数据库（2004-2015 年）中确定了接受 RP 治疗且病理分期为 T2 或 T3a 的男性患者。绘制了 PSM 发生率的年度趋势图。亚组重点关注地理区域，即中北部、东北部、南部和西部。累积发病率图描绘了其他原因死亡率校正后的 CSM 率。多变量竞争风险回归模型测试了 PSM 与 CSM 之间的关系。亚组分析侧重于病理分期、Gleason 评分和地理区域。
在接受 RP 治疗的 153329 例患者中，12.3%（n=18935）出现 PSM。总体而言，在病理 T2 期和病理 T3a 期，研究期间 PSM 率从 18.7%降至 9.7%（P<.001）、15.7%降至 7.3%（P<.001）和 39.0%降至 18.0%（P<.001）。在重点关注地理区域的亚组分析中，PSM 率普遍下降。然而，下降幅度不同。在多变量竞争风险回归模型中，PSM 率与更高的 CSM 相关（风险比，1.45；P<.001）。然而，地理区域未能成为独立的预测因素。关于 PSM 局灶性、长度和相关 Gleason 评分的信息不足是重要的局限性。
令人鼓舞的是，即使按肿瘤分期分层，研究期间 PSM 率仍呈下降趋势。在 4 个检查的地理区域内，PSM 下降。然而，下降幅度不同，但地理区域并不是 PSM 的独立预测因素。
