Close Surgical Margins after Radical Prostatectomy Are an Independent Predictor of Prostate Cancer Recurrent
Gregory Wirth, Jian Lu, Shulin Wu, Douglas M Dahl, Aria F Olumi, W Scott McDougal, Robert H Young, Chin-Lee Wu. Massachusetts General Hospital, Boston, MA
Background: The term close surgical margin (CSM) refers to a tumor extending close to (less than 0.1 mm) the inked margin of the radical prostatectomy specimen without reaching it. Current guidelines state that CSM should simply be reported as negative. The clinical significance of CSM has not be fully studied. This study is to evaluate the impact of CSM on the long−term risk of biochemical recurrence following radical prostatectomy.
Design: We identified 1195 consecutive patients who underwent radical prostatectomy for localized prostate cancer in our institution. In 894 of these patients, associations between margin status and location, Gleason score, pathological stage, pre−operative PSA, prostate weight, and age with the risk of biochemical recurrence were examined.
Results: Six−hundred forty−four of 894 patients (72%) had negative margins. Of these patients, 100 (15.5%) had CSM. In the group with PSA failure, median time to recurrence was 3.5 years. In the group without recurrence, median follow−up was 9.9 years. Cumulative recurrence−free survival differed significantly among the three types of margins (positive, negative and close) (p<0.001). On multivariate analysis, CSM constituted a significant, independent predictor of recurrence (HR 2.23 95%CI 1.08−4.99). Gleason score and positive margins were the strongest prognostic factors.
Conclusions: In this cohort, CSM were independently associated with a two-fold risk of postoperative biochemical recurrence. Further evaluation of the clinical significance of CSM is indicated, as they might be an indicator of local recurrence and of relevance when considering salvage therapy.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 168, Wednesday Afternoon