Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Ahyai, SA; Zacharias, M; Isbarn, H; Steuber, T; Eichelberg, C; Köllermann, J; Fisch, M; Karakiewicz, PI; Huland, H; Graefen, M; Chun, FK.
Prognostic significance of a positive surgical margin in pathologically organ-confined prostate cancer.
BJU Int. 2010; 106(4):478-83
Doi: 10.1111/j.1464-410X.2009.09162.x
Web of Science
PubMed
FullText
FullText_MUG
- Führende Autor*innen der Med Uni Graz
- Ahyai Sascha
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- Abstract:
- OBJECTIVE: To identify risk factors of a positive surgical margin (PSM) and the significance of a PSM after radical prostatectomy (RP) on biochemical recurrence (BCR) in exclusively pathologically confirmed organ-confined (OC) prostate cancer, as despite an excellent prognosis after RP, some patients with pathologically confirmed OC disease have BCR, and the prognostic significance of a PSM in these men remains unclear. PATIENTS AND METHODS: We assessed 932 men with pathologically OC disease who were treated with RP by nine different surgeons between 1992 and 2004. The prognostic significance of clinical and pathological variables, including tumour volume (TV) and percentage of high-grade TV (%HGTV) were assessed. Logistic and Cox regression models were fitted to identify risk factors of a PSM and BCR. BCR was defined as a prostate-specific antigen (PSA) level of 0.1 ng/mL and increasing after an undetectable PSA level. RESULTS: The total PSM rate was 12.9% (120 men); the mean TV (P < 0.001), but not %HGTV (P= 0.2) was significantly higher in patients with PSM. TV, nerve-sparing RP technique and surgical volume were independent risk factors for a PSM (P= 0.03). After a median follow-up of 35 months the overall BCR rate was 8.8% (82 men). Patients with a PSM had significantly higher BCR rates (21.7% vs 6.9%; P < 0.001). In univariable analysis, a high %HGTV (70.4%) was the most informative risk factor of BCR, followed by RP Gleason score (65.8%) and PSM (65.7%). Removal of PSM from a multivariable Cox model decreased the accuracy by 12.1% (P < 0.001). CONCLUSIONS: Our findings show that in OC prostate cancer, the risk of a PSM depends on TV, surgical technique and surgical volume. PSM is a significant risk factor for BCR. However, only 20% men with OC disease and a PSM develop BCR; conversely, 80% of men are cured despite a PSM. Therefore, adjuvant therapy must be considered, with caution to avoid unnecessary overtreatment.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult - administration & dosage
- Aged - administration & dosage
- Epidemiologic Methods - administration & dosage
- Humans - administration & dosage
- Male - administration & dosage
- Middle Aged - administration & dosage
- Neoplasm Recurrence, Local - pathology
- Neoplasm, Residual - administration & dosage
- Prognosis - administration & dosage
- Prostate - pathology, surgery
- Prostate-Specific Antigen - metabolism
- Prostatectomy - methods
- Prostatic Neoplasms - pathology, surgery
- Tumor Burden - administration & dosage
- Find related publications in this database (Keywords)
- prostate cancer
- tumour volume
- biochemical recurrence
- surgical margin
- surgical volume
- radical prostatectomy