It has been suggested that a very short positive margin does not confer additional risk of BCR after radical prostatectomy.
This study shows that even very short PSM is associated with increased risk of BCR.
OBJECTIVE:To re-evaluate, in a larger cohort with longer follow-up, our previously reported finding that a positive surgical margin (PSM) ≤ 1 mm may not confer an additional risk for biochemical recurrence (BCR) compared with a negative surgical margin (NSM).
PATIENTS AND METHODS:Margin status and length were evaluated in 2866 men treated with radical prostatectomy (RP) for clinically localized prostate cancer at our institution from 1994 to 2009. We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen (PSA) level, age, pathological stage and pathological Gleason score (GS).
RESULTS:Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all). In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [HR] 2.2), as were a higher PSA level (HR 1.04), higher pathological stage (HR 2.7) and higher pathological GS (HR 3.7 [all P < 0.001]).
CONCLUSION: In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates.
Written by:
Shikanov S, Marchetti P, Desai V, Razmaria A, Antic T, Al-Ahamadie H, Zagaja G, Eggener S, Brendler C, Shalhav A. Are you the author?
Department of Surgery, University of Chicago Hospitals, Chicago, IL; Department of Pathology, Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: BJU Int. 2012 Jul 3. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11340.x
PubMed Abstract
PMID: 22759270
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