Prognostic Impact of Subclassification of Radical Prostatectomy Positive Margins by Linear Extent and Gleason Grade.
Samson W Fine, Kazuma Udo, Angel M Cronin, Lauren J Carlino, Hikmat A Al-Ahmadie, Anuradha Gopalan, Satish K Tickoo, Peter T Scardino, James A Eastham, Victor E Reuter. Memorial Sloan-Kettering Cancer Center, NY
Background: The finding of a positive surgical margin (+SM) is an independent adverse prognostic factor in patients who have undergone radical prostatectomy for prostate cancer. A few studies have highlighted the prognostic significance of length of +SM and Gleason grade at the site of a +SM, yet the impact of these factors remains unclear. Utilizing detailed pathologic review, we aimed to evaluate the relationship between the linear extent of and Gleason grade at a +SM with progression following radical prostatectomy.
Design: We studied 2150 prostatectomies with pT2 or pT3a disease for grade, stage, and margin status. In +SM patients, location, number and linear extent of and highest Gleason grade at margins were recorded.
Results: 207 (10%) cases displayed a +SM with 45% (n=93) having pT2+ and 55% (n=114) having pT3a disease. pT3a +SM patients had higher PSA, tumor volumes and rates of Gleason score ≥ 7 compared to pT2+ patients. 45 patients with +SM progressed. Sub-categorization of +SM revealed most patients with 1 +SM (79%, n=164) and total margin length ≤ 1mm for 104 patients (50%), 1.1 to 3mm for 55 patients (27%), and >3mm for 48 patients (23%). 2-year progression-free probabilities were 95%, 91%, 83% and 47% for patients with negative margins, ≤ 1mm, 1.1 to 3mm and >3mm linear extent, respectively (p<0.001). 154 (74%) cases had highest Gleason grade 3 at +SM, while 53 (26%) had Gleason grade 4/5. The latter group were significantly more likely to progress (p<0.001). Concordance index of overall margin status was 0.636 and was not considerably enhanced with categorization by linear extent (concordance index 0.643).
Conclusions: Length of and Gleason grade at a positive surgical margin are associated with progression. However, categorization by linear extent did not add importantly to a model using margin status only. More robust markers are needed in positive surgical margin patients to warrant routine reporting and identify patients at risk for biochemical recurrence.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 1:00 PM
Poster Session II # 122, Monday Afternoon