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Multicenter Study
. 2019 May 15;19(1):37.
doi: 10.1186/s12894-019-0470-8.

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Yoann Koskas  1 , François Lannes  2 , Nicolas Branger  2 , Sophie Giusiano  3 , Nicolas Guibert  4   5 , Géraldine Pignot  6 , Jochen Walz  6 , Dominique Rossi  2 , Cyrille Bastide  2
Affiliations
Multicenter Study

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Yoann Koskas et al. BMC Urol. .

Abstract

Background: To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up.

Methods: This retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups: - Focal PSM (fPSM): single PSM (sPSM) ≤3 mm; - Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length.

Results: The median follow-up was 101 months (18-283) and the median age was 63 years (46-76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25-11.49). The ePSM significantly decreased BR-free survival (p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001).

Conclusion: With a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.

Keywords: Biochemical recurrence; Extent; Focal positive surgical margins; Positive surgical margins; Prostate cancer; Radical prostatectomy.

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Conflict of interest statement

Ethics approval and consent to participate

This study protocol was reviewed and approved by the ethic committee of French Association of Urology (ref: 2018/010) and obtaining additional informed consent from patients was not required by the ethic committee for this retrospective study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves showing biochemical recurrence (BR)-free survival following. a All patients. b pT2 Stage. c pT3a Stage. Legends: fPSM: focal positive surgical margin; ePSM: extensive positive surgical margin
See this image and copyright information in PMC

References

    1. Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. 2014;65(2):303–313. - PubMed
    1. Chalfin HJ, Dinizo M, Trock BJ, Feng Z, Partin AW, Walsh PC, et al. Impact of surgical margin status on prostate-cancer-specific mortality. BJU Int. 2012;110(11):1684–1689. - PMC - PubMed
    1. Tan PH, Cheng L, Srigley JR, Griffiths D, Humphrey PA, Van Der Kwast TH, et al. International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 5: surgical margins. Mod Pathol. 2011;24(1):48–57. - PubMed
    1. Pfitzenmaier J, Pahernik S, Tremmel T, Haferkamp A, Buse S, Hohenfellner M. Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression? BJU Int. 2008;102(10):1413–1418. - PubMed
    1. Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH, et al. Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol. 2010;183(6):2213–2218. - PMC - PubMed

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