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Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ‐confined prostate cancer
Author(s) -
Preisser Felix,
Coxilha Gilberto,
Heinze Alexander,
Oh Su,
Chun Felix KH.,
Sauter Guido,
Pompe Raisa S.,
Huland Hartwig,
Graefen Markus,
Tilki Derya
Publication year - 2019
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.23908
Subject(s) - biochemical recurrence , medicine , prostate cancer , hazard ratio , prostatectomy , proportional hazards model , urology , breakpoint cluster region , surgical margin , stage (stratigraphy) , overall survival , cancer , oncology , confidence interval , biology , receptor , paleontology
Background Positive surgical margins (PSMs) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality, and the PSM Gleason, on biochemical recurrence (BCR) in organ‐confined RP patients. Methods Within a high‐volume center database, we identified patients who harbored organ‐confined (pathologic stage T2 disease) prostate cancer (PCa) at RP (2010‐2016). Kaplan‐Meier analyses and multivariable Cox regression models were used to test the effect of the PSM on the BCR risk. Results Overall, 8770 patients were identified. Of those, 6.6% (n = 579) harbored PSM. BCR‐free survival at 72 months after RP was 77.7% vs 89.0% for patients with vs without PSM ( P < .001). BCR‐free survival rates at 72 months were 77.4% vs 73.6% ( P = .1) for unifocal vs multifocal PSM, 77.2% vs 71.8% ( P = .03) for Gleason pattern 3 vs ≥4 at the margin and 88.4% vs 66.3% ( P < .001) for <3 vs ≥3 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR] = 2.40, P < .001). However, in subgroups with PSM, only ≥3 mm PSM represented an independent predictor (HR = 1.93, P = .04), while focality and Gleason at the margin were no significant predictors. Conclusion PSM represents an independent predictor for BCR in organ‐confined PCa at RP. Moreover, Gleason ≥4 at the margin and ≥3 mm PSM length were associated with worse BCR‐free survival. Closer surveillance of patients with organ‐confined PCa at RP and PSM can help to identify those who qualify for early salvage radiotherapy.