Urology Department, CHU Lille, F-59000, Lille, France.
University of Lille, GIVRE - MERCS - Module for Education and Research Collaboration in Statistics, F-59000, Lille, France.
BMC Cancer. 2018 Dec 27;18(1):1291. doi: 10.1186/s12885-018-5229-1.
There are no published studies on the simultaneous effect of extent and location of positive surgical margins (PSMs) on biochemical recurrence (BCR) after robot-assisted laparoscopic prostatectomy (RALP). The aim was to report the incidence, extent, and location of PSMs over the inclusion period as well as the rates of BCR and cancer-related mortality, and determine if BCR is associated with PSM extent and/or location.
Retrospective review of 530 consecutive patients who underwent RALP between 2003 and 2012. Kaplan-Meier (KM) survival analyses and Cox regressions were performed to determine variables associated with BCR.
For the 530 operated patients, evaluated at a median of 92 months (IQR, 87-99), PSMs were observed in 156 (29%), of which 24% were focal. Out of 172 PSMs, 126 (73%) were focal and 46 (27%) were extensive. The KM survival using BCR as endpoint was 0.81 (CI, 0.78-0.85) at 5 years and was 0.67 (CI, 0.61-0.72) at 10 years; and using cancer-related mortality as endpoint was 0.99 (CI, 0.99-1.00) at 5 years and 0.95 (CI, 0.92-0.98) at 10 years. Multi-variable analysis revealed the strongest predictors of BCR to be Gleason score ≥ 8 (HR = 7.97; CI, 4.38-14.51) and 4 + 3 (HR = 3.88; CI, 2.12-7.07), lymph nodes invasion (HR = 3.42; CI, 1.70-6.91), pT stage 3b or 4 (HR = 3.07; CI, 1.93-4.90), and extensive apical PSMs (HR = 2.62; CI, 1.40-4.90) but not focal apical PSMs (HR = 0.86; CI, 0.49-1.50; p = 0.586).
Extensive apical PSMs significantly increased the risk of BCR, independently from pT stage, Gleason score and lymph nodes invasion, while focal apical PSMs had no significant effect on BCR.
目前尚无研究报道机器人辅助腹腔镜前列腺切除术（RALP）后阳性切缘（PSM）的范围和位置对生化复发（BCR）的同时影响。本研究旨在报告纳入期间 PSM 的发生率、范围和位置，以及 BCR 和癌症相关死亡率的发生率，并确定 BCR 是否与 PSM 的范围和/或位置有关。
对 2003 年至 2012 年间接受 RALP 的 530 例连续患者进行回顾性分析。采用 Kaplan-Meier（KM）生存分析和 Cox 回归分析确定与 BCR 相关的变量。
在中位随访 92 个月（IQR，87-99）的 530 例手术患者中，156 例（29%）出现 PSM，其中 24%为局灶性。在 172 个 PSM 中，126 个（73%）为局灶性，46 个（27%）为广泛性。以 BCR 为终点的 KM 生存分析显示，5 年时为 0.81（CI，0.78-0.85），10 年时为 0.67（CI，0.61-0.72）；以癌症相关死亡率为终点的 KM 生存分析显示，5 年时为 0.99（CI，0.99-1.00），10 年时为 0.95（CI，0.92-0.98）。多变量分析显示，BCR 的最强预测因子为 Gleason 评分≥8（HR=7.97；CI，4.38-14.51）和 4+3（HR=3.88；CI，2.12-7.07）、淋巴结侵犯（HR=3.42；CI，1.70-6.91）、pT 期 3b 或 4（HR=3.07；CI，1.93-4.90）和广泛的尖部 PSM（HR=2.62；CI，1.40-4.90），但不是局灶性尖部 PSM（HR=0.86；CI，0.49-1.50；p=0.586）。
广泛的尖部 PSM 显著增加了 BCR 的风险，与 pT 分期、Gleason 评分和淋巴结侵犯独立相关，而局灶性尖部 PSM 对 BCR 无显著影响。
