Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Prostate. 2022 Jun;82(9):949-956. doi: 10.1002/pros.24341. Epub 2022 Mar 28.
Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the Gleason grade at the PSM, on the oncologic outcomes in nonorgan-confined RP patients.
Within a high-volume center database, we identified patients who harbored non-organ-confined (pT3) prostate cancer (PCa) at RP between 2010 and 2016. Only patients without lymph node invasion were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of PSM on biochemical recurrence (BCR), metastasis, and cancer-specific death after RP in patients without adjuvant radiotherapy.
Overall, 3705 patients were identified. Of those, 27.2% (n = 1007) harbored PSM. At 96 months after RP, BCR-free, metastasis-free and cancer-specific survival was 41.6 versus 57.5%, 82.7 versus 88.6%, and 94.7 versus 98.5% for patients with versus without PSM (all p < 0.001). BCR-free, metastasis-free and cancer-specific survival rates at 96 months were 56.7 versus 26.5% (p < 0.001), 94.4 versus 67.4% (p < 0.001), and 100.0 versus 87.1% (p < 0.01) for Gleason pattern 3 versus ≥ 4 at the margin and 45.0 versus 27.8% (p < 0.01), 83.3 versus 82.3% (p = 0.2), and 95.2 versus 92.7% (p = 0.3) for <4 mm versus ≥4 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR]:1.53, p < 0.001) and cancer-specific death (HR:2.75, p = 0.02). In subgroups of patients with PSM only, Gleason ≥ 4 at the margin (HR:1.60, p < 0.01) and length of PSM (HR:1.02, p < 0.05) was an independent predictor of BCR.
PSM represents an independent predictor for worse oncologic outcome in nonorgan-confined PCa at RP. Gleason ≥ 4 at the margin was associated with the development of BCR, metastasis, and with cancer-specific death after RP. Next to margin status, Gleason at the margin and its length carry important information that should be reported for the specimen.
阳性切缘（PSM）代表根治性前列腺切除术（RP）中预后不良的一个因素。为了研究PSM 及其长度、PSM 的局灶性和 Gleason 分级对非器官受限 RP 患者肿瘤学结局的影响。
在一个高容量中心数据库中，我们确定了 2010 年至 2016 年间在 RP 中存在非器官受限（pT3）前列腺癌（PCa）的患者。仅纳入无淋巴结侵犯的患者。使用 Kaplan-Meier 分析和多变量 Cox 回归模型来检测 PSM 对无辅助放疗的 RP 后生化复发（BCR）、转移和癌症特异性死亡的影响。
总体而言，确定了 3705 名患者。其中，27.2%（n=1007）存在 PSM。在 RP 后 96 个月，BCR 无复发生存、无转移生存和癌症特异性生存分别为 41.6%比 57.5%（均 p<0.001）、82.7%比 88.6%（均 p<0.001）和 94.7%比 98.5%（均 p<0.001）。在 RP 后 96 个月，BCR 无复发生存率、无转移生存率和癌症特异性生存率分别为 56.7%比 26.5%（p<0.001）、94.4%比 67.4%（p<0.001）和 100.0%比 87.1%（p<0.01），PSM 处的 Gleason 模式 3 比≥4 以及 45.0%比 27.8%（p<0.01）、83.3%比 82.3%（p=0.2）和 95.2%比 92.7%（p=0.3）。在多变量 Cox 模型中，PSM 是 BCR（危险比[HR]：1.53，p<0.001）和癌症特异性死亡（HR：2.75，p=0.02）的独立预测因子。在 PSM 仅存在的患者亚组中，PSM 处的 Gleason≥4（HR：1.60，p<0.01）和 PSM 长度（HR：1.02，p<0.05）是 BCR 的独立预测因子。
PSM 是 RP 中非器官受限 PCa 肿瘤学结局较差的独立预测因子。PSM 处的 Gleason≥4 与 RP 后 BCR、转移和癌症特异性死亡的发生相关。除了边缘状态外，边缘处的 Gleason 分级及其长度提供了重要信息，应在标本中报告。
