Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
Institute of Pathology, Ruhr-University Bochum, Bochum, Germany.
BJU Int. 2021 Nov;128(5):598-606. doi: 10.1111/bju.15446. Epub 2021 Jun 6.
To identify patients at risk for biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP) with intra-operative whole-mount frozen section (FS) of the prostate.
We examined differences in BCR between patients with initial negative surgical margins at FS, patients with final negative surgical margins with initial positive margins at FS without residual PCa after secondary tumour resection, and patients with final negative surgical margins with initially positive margins at FS with residual PCa in the secondary tumour resection specimen. Institutional data of 883 consecutive patients undergoing RP were collected. Intra-operative whole-mount FS was routinely used to check for margin status and, if necessary, to resect more periprostatic tissue in order to achieve negative margins. Patients with lymph node-positive disease or final positive surgical margins were excluded from the analysis. Kaplan-Meier curves and multivariable Cox proportional hazards regression analyses adjusting for clinical covariates were employed to examine differences in biochemical recurrence-free survival (BRFS) according to the resection status mentioned above.
The median follow-up was 22.4 months. The 1- and 2-year BRFS rates in patients with (81.0% and 72.9%, respectively; P = 0.001) and without residual PCa (90.3% and 82.3%, respectively; P = 0.033) after secondary tumour resection were significantly lower compared to patients with initial R0 status (93.4% and 90.9%, respectively). On multivariable Cox regression only residual PCa in the secondary tumour resection was associated with a higher risk of BCR compared to initial R0 status (hazard ratio 1.99, 95% confidence interval 1.01-3.92; P = 0.046).
Despite being classified as having a negative surgical margin, patients with residual PCa in the secondary tumour resection specimen face a high risk of BCR. These findings warrant closer post-RP surveillance of this particular subgroup. Further research of this high-risk subset of patients should focus on examining whether these patients benefit from early salvage therapy and how resection status impacts oncological outcomes in the changing landscape of PCa treatment.
通过对前列腺癌根治术后的前列腺进行术中全器官冰冻切片（FS），确定前列腺癌根治术后生化复发（BCR）的高危患者。
我们比较了 FS 初始切缘阴性、FS 初始切缘阳性而二次肿瘤切除后切缘阴性、FS 初始切缘阳性且二次肿瘤切除标本中仍有肿瘤残余的患者之间的 BCR 差异。我们收集了 883 例连续接受前列腺癌根治术的患者的机构数据。术中全器官 FS 常规用于检查切缘状态，如果需要，切除更多的前列腺周围组织以达到阴性切缘。患有淋巴结阳性疾病或最终切缘阳性的患者被排除在分析之外。采用 Kaplan-Meier 曲线和多变量 Cox 比例风险回归分析，根据上述切除状态调整临床协变量，评估生化无复发生存率（BRFS）的差异。
中位随访时间为 22.4 个月。在二次肿瘤切除后无残余肿瘤的患者中，1 年和 2 年 BRFS 率分别为 81.0%和 72.9%（P = 0.001），显著低于二次肿瘤切除后有残余肿瘤的患者（分别为 90.3%和 82.3%；P = 0.033）。多变量 Cox 回归分析显示，只有二次肿瘤切除标本中仍有肿瘤残余与初始 R0 状态相比，BCR 的风险更高（危险比 1.99，95%置信区间 1.01-3.92；P = 0.046）。
尽管被归类为切缘阴性，但在二次肿瘤切除标本中仍有肿瘤残余的患者发生 BCR 的风险很高。这些发现表明，这一特定亚组患者需要更密切的前列腺癌根治术后监测。对这一高危患者亚组的进一步研究应侧重于研究这些患者是否受益于早期挽救性治疗，以及切缘状态如何影响前列腺癌治疗不断变化的格局中的肿瘤学结果。
