Panunzio Andrea, Sorce Gabriele, Hoeh Benedikt, Hohenhorst Lukas, Tappero Stefano, Nimer Nancy, Rajwa Pawel, Tian Zhe, Terrone Carlo, Chun Felix K H, Briganti Alberto, Saad Fred, Shariat Shahrokh F, Cerruto Maria Angela, Antonelli Alessandro, Karakiewicz Pierre I
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2023 Feb;83(3):268-276. doi: 10.1002/pros.24458. Epub 2022 Nov 6.
The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients.
We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients.
Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p < 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p < 0.001) and lymph node involvement (14.1% vs. 9.4%, p < 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models.
In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
在具有侵袭性 Gleason 分级组（GGG）的高/极高风险（HR/VHR）前列腺癌（PCa）中，手术切缘阳性（PSM）对癌症特异性死亡率（CSM）的影响尚不清楚。除了测试放疗（RT）对 PSM 患者的益处外，我们还在这种情况下测试了 PSM 对 CSM 的影响。
我们依据监测、流行病学和最终结果数据库（2010 - 2015 年），聚焦于根治性前列腺切除术（RP）时仅为 GGG 4 - 5 的 HR/VHR 患者。采用 Kaplan - Meier 曲线和多变量 Cox 回归模型来测试 PSM 与 CSM 之间的关系。此外，还在 PSM 患者中探究了 RT 对 CSM 的影响。
在 3383 例 HR/VHR 患者中，15.1%（n = 511）出现 PSM。与无 PSM 的患者相比，PSM 患者中 GGG 5 的比例更高（60.1%对 50.9%，p < 0.001），病理肿瘤分期为 T3a 的比例更高（69.1%对 45.2%，p < 0.001），淋巴结受累的比例更高（14.1%对 9.4%，p < 0.001）。PSM 发生率随时间（2010 - 2015 年）从 16.0%降至 13.6%。有和无 PSM 的患者 7 年无 CSM 生存率分别为 91.6%和 95.7%。在多变量 Cox 回归模型中，即使在调整了年龄、前列腺特异性抗原、病理肿瘤分期和淋巴结状态后，PSM 仍是 CSM 的独立预测因素（风险比 = 1.6，p = 0.040）。最后，在 PSM 患者中，单变量或多变量 Cox 回归模型中 RT 治疗均未降低 CSM。
在仅为 GGG 4 - 5 的 HR/VHR PCa 患者中，RP 时的 PSM 对生存有不利影响。此外，RT 对 CSM 没有保护作用。因此，在这类患者中尽可能降低 PSM 发生率至关重要。
