The Length of Positive Surgical Margins Correlates with Biochemical Recurrence after Radical Prostatectomy
IM van Oort, HM Bruins, L Kiemeney, JA Witjes, CA Hulsbergen-van de Kaa. Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Background: The presence of positive surgical margins (+SM) in a radical prostatectomy (RP) specimen is an important negative prognostic factor, but it is still uncertain whether the extent of +SM affects clinical outcome as an independent factor. We evaluated the prognostic role of the linear length of +SM for biochemical recurrence (BCR) after RP for prostate cancer.
Design: Data of 267 consecutive RP specimens with +SM were analyzed. All RP specimens were sectioned at 4-mm intervals and completely embedded. Evaluation was done by one uropathologist. BCR was defined as two consecutive PSA levels above 0.10 ng/mL. Data were analyzed using Kaplan-Meier survival analysis and proportional hazards models.
Results: In the total group of 267 patients, the length of +SM ranged from 0.4 to 174.5 mm (median 11.2 mm; mean 21.9 mm) and was positively correlated with preoperative PSA (p< 0.001), pathologic stage (p < 0.001), tumor volume (p = 0.001), number of positive sites (p <0.001), Gleason grade at the positive margin (p < 0.001) and with Gleason score (p = 0.015). The mean length of +SM in 93 patients with persistent increased postoperative PSA levels and/or adjuvant therapy was significantly higher than in the remaining 174 patients (32.6 mm vs. 15.4 mm; p<0.001). In the 174 patients with an undetectable postoperative PSA level (median follow-up of 36.3 months) the 5-years risk of BCR was 29%. The risk of BCR for patients with +SM 10 mm and > 10 mm was 21% and 39%, respectively. In multivariate analyses BCR was associated with an increasing length of +SM (HR 2.15; 95% CI 1.12-4.15; p = 0.022), but not with preoperative PSA, pathological stage, Gleason score, tumor volume or Gleason grade at the resection margin.
Conclusions: The length of the positive surgical margin is an independent predictive factor for PSA recurrence after radical prostatectomy.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 129, Tuesday Afternoon