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High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T 3a prostate cancer with a negative surgical margin
Author(s) -
You Dalsan,
Jeong In Gab,
Song Cheryn,
Cho Yong Mee,
Hong Jun Hyuk,
Kim ChoungSoo,
Ahn Hanjong
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12348
Subject(s) - medicine , hazard ratio , lymphovascular invasion , prostatectomy , urology , surgical margin , prostate cancer , pathological , biochemical recurrence , prostate specific antigen , stage (stratigraphy) , proportional hazards model , t stage , oncology , cancer , prostate , adjuvant therapy , receiver operating characteristic , metastasis , confidence interval , paleontology , biology
Objectives To evaluate the impact of percent tumor volume and surgical margin status on biochemical recurrence in pT3 – T 4 prostate cancer. Methods A total of 397 patients who had pT3 – T4N0 diseases and did not receive neoadjuvant or adjuvant therapy were included for analysis. Results In the entire cohort, prostate‐specific antigen (per 1 ng/mL increase; hazard ratio 1.019; P = 0.002), pathological stage ( T 3b– T 4 vs T 3a; hazard ratio 2.283; P < 0.001), G leason score (≥8 vs ≤6; hazard ratio 5.290; P = 0.005), surgical margin status (multiple positive vs negative; hazard ratio 1.839; P = 0.003) and lymphovascular invasion (present vs absent; hazard ratio 1.641; P = 0.008) were independent predictors of recurrence. Percent tumor volume was an independent predictor of recurrence in T 3a diseases with negative surgical margins. In analysis using receiver operating characteristic curve, a threshold of 12% showed the best balance of sensitivity and specificity, 66% and 67%, respectively. The 5‐year recurrence‐free survival rates of pT3a diseases with negative surgical margin were 85.2% for percent tumor volume ≤12% and 57.7% for percent tumor volume >12% ( P < 0.001). Patients with pT3a with negative surgical margins and percent tumor volume >12% showed comparable 5‐year recurrence‐free survival rate compared with those with pT3a with positive surgical margin (57.7% vs 57.6%; P = 0.763). Conclusions Despite having less impact on recurrence than other clinicopathological variables in pT3 – T 4 prostate cancer, percent tumor volume can further improve recurrence risk stratification in pT3a diseases with negative surgical margins.