Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Eur Urol Oncol. 2021 Feb;4(1):42-48. doi: 10.1016/j.euo.2019.03.006. Epub 2019 Apr 5.
The impact of positive surgical margins (PSMs) on the risk of metastases in prostate cancer (PCa) patients treated with radical prostatectomy (RP) is still debated.
To identify PSM features associated with recurrence in a stage-by-stage analysis.
DESIGN, SETTING, AND PARTICIPANTS: A total of 1757 PCa patients treated with RP without neoadjuvant or adjuvant treatments between 2011 and 2017 were identified. Patients were stratified according to the presence of PSM and to margins characteristics in three groups: no versus favourable (single margin <3mm) versus unfavourable (≥3mm or multifocal margin) PSMs.
Predictors of biochemical recurrence (BCR) and clinical recurrence (CR) were assessed using semiparametric Cox proportional hazard models.
Overall, 285 (16%) patients had PSMs; 146 (51%) had a unifocal PSM, while 139 (49%) had a multifocal PSM. The median length of a PSM was 1mm. Overall, 120 (42%) versus 165 (58%) patients had favourable versus unfavourable PSMs. In patients with ≤pT3a and pathologic grade group ≤3 disease (n=1351), favourable (hazard ratio [HR]: 2.24; 95% confidence interval [CI]: 1.19-4.22) and unfavourable (HR: 2.68; 95% CI: 1.49-4.84) PSMs significantly increased the risk of BCR (p<0.01). However, they were not associated with CR (all p>0.05). Conversely, in patients with pT3b/4 and/or pathologic grade group 4-5 and/or pN1 (n=406), only an unfavourable PSM was associated with both BCR (HR: 2.96; 95% CI: 1.19-4.22) and CR (HR: 2.60; 95% CI: 1.07-6.30; all p≤0.04).
Although the presence of PSMs was associated with an increased risk of BCR in all stages, only men with adverse pathologic characteristics and an unfavourable PSM were at an increased risk of experiencing metastases as compared with their counterparts with no or a single margin shorter than 3mm.
In this study, we defined a new category of unfavourable positive surgical margins (namely, ≥3mm and/or multifocal), which confers a higher risk of developing metastasis in men with more aggressive pathologic features.
在接受根治性前列腺切除术 (RP) 治疗的前列腺癌 (PCa) 患者中，阳性切缘 (PSM) 对转移风险的影响仍存在争议。
在分期分析中确定与复发相关的 PSM 特征。
设计、设置和参与者：共确定了 1757 例在 2011 年至 2017 年间未接受新辅助或辅助治疗的接受 RP 治疗的 PCa 患者。根据是否存在 PSM 以及在三组中 PSM 特征（无、有利 (单一边缘 <3mm) 和不利 (≥3mm 或多灶边缘)) 将患者分层。
使用半参数 Cox 比例风险模型评估生化复发 (BCR) 和临床复发 (CR) 的预测因素。
总体而言，285 (16%) 例患者存在 PSM；146 (51%) 例存在单灶 PSM，139 (49%) 例存在多灶 PSM。PSM 的中位长度为 1mm。总体而言，120 (42%) 例患者的 PSM 有利，165 (58%) 例患者的 PSM 不利。在 ≤pT3a 和病理分级组 ≤3 疾病的患者 (n=1351) 中，有利 (危险比 [HR]：2.24；95%置信区间 [CI]：1.19-4.22) 和不利 (HR：2.68；95% CI：1.49-4.84) PSM 显著增加了 BCR 的风险 (p<0.01)。然而，它们与 CR 无关 (均 p>0.05)。相反，在 pT3b/4 和/或病理分级组 4-5 和/或 pN1 患者 (n=406) 中，只有不利的 PSM 与 BCR (HR：2.96；95% CI：1.19-4.22) 和 CR (HR：2.60；95% CI：1.07-6.30；均 p≤0.04) 相关。
尽管所有阶段的 PSM 存在均与 BCR 风险增加相关，但只有具有不良病理特征和不利 PSM 的男性与无 PSM 或单一边缘 <3mm 的男性相比，更有可能发生转移。
在这项研究中，我们定义了一种新的不利的阳性切缘类别（即≥3mm 和/或多灶），这在具有更具侵袭性病理特征的男性中增加了发生转移的风险。
