The effect of surgical margin features on oncologic outcomes after radical prostatectomy

IF 0.5 Q4 UROLOGY & NEPHROLOGY

African Journal of Urology Pub Date : 2024-08-21 DOI:10.1186/s12301-024-00445-y

Mubariz Aydamirov, Mutlu Deger, Nebil Akdogan, Ismail Onder Yilmaz, Sevinc Puren Yucel Karakaya, Tugba Toyran, Seyda Erdogan, Yildirim Bayazit, Volkan Izol

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Abstract

Evaluation of the effect of additional surgical margin parameters on biochemical recurrence (BCR) in patients with positive surgical margins (PSM) after radical prostatectomy (RP). Clinicopathological and outcome data from 91 patients with PSM who underwent RP were retrospectively analyzed. Additional surgical margin parameters (PSM length, highest Gleason grade (GG), localization of PSM (apex, bladder neck, or posterolateral), and unifocality or multifocality) were examined and their effects on BCR were investigated. Fifty patients with PSM were included in the study. The mean age of the patients was 63.6 ± 6.9 years. The laparoscopic approach was undertaken more frequently, used for 36 (72%) patients compared to open RP performed in 14 cases (28%). The median follow-up time was 57.0 months (24.0–125.0 months). BCR developed in 14 (28%) patients during the follow-up period. Although mean BCR-free survival was shorter in cases with PSM length ≥ 3 mm compared to those with PSM length < 3 mm (90.4 vs. 108.2 months), multifocality compared to those with unifocality (62 vs. 97.4 months) and surgical margin GG ≥ 4 compared to those with GG 3 (87.4 vs. 97.5 months), the differences were not statistically significant (p = 0.251, p = 0.509 and p = 0.317, respectively). In addition, none of the PSM localizations affected BCR-free survival (p = 0.619). In univariate Cox regression analysis, PSM length affected BCR at a level close to statistical significance (HR = 1.16; p = 0.052). In multiple Cox regression analysis, main tumor Gleason score was determined to be a risk factor associated with BCR (HR = 4.75; p = 0.041). Although BCR-free survival was shortened in the presence of poor prognostic features (multifocal PSM, PSM length ≥ 3 mm, surgical margin GG ≥ 4) at the surgical margin, none of these parameters affected BCR at a statistically significant level. Gleason score of the main tumor was found to be a better prognostic factor for BCR.

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手术切缘特征对前列腺癌根治术后疗效的影响

评估根治性前列腺切除术（RP）后手术切缘阳性（PSM）患者的额外手术切缘参数对生化复发（BCR）的影响。我们对 91 名接受前列腺癌根治术的 PSM 患者的临床病理和结果数据进行了回顾性分析。研究还检查了其他手术边缘参数（PSM长度、最高格里森分级（GG）、PSM定位（顶点、膀胱颈或后外侧）、单发性或多发性），并探讨了它们对BCR的影响。研究共纳入了 50 名 PSM 患者。患者的平均年龄为（63.6 ± 6.9）岁。36例（72%）患者采用腹腔镜方法，14例（28%）采用开腹RP方法。中位随访时间为 57.0 个月（24.0-125.0 个月）。在随访期间，14 例（28%）患者出现了 BCR。虽然PSM长度≥3毫米的病例平均无BCR生存期比PSM长度<3毫米的病例短（90.4个月比108.2个月），多发病例比单发病例短（62个月比97.4个月），手术边缘GG≥4的病例比GG3的病例短（87.4个月比97.5个月），但差异无统计学意义（分别为P = 0.251、P = 0.509和P = 0.317）。此外，PSM定位均不影响无BCR生存期（p = 0.619）。在单变量 Cox 回归分析中，PSM 长度对 BCR 的影响接近统计学显著性水平（HR = 1.16；p = 0.052）。在多重考克斯回归分析中，主要肿瘤格里森评分被确定为与 BCR 相关的风险因素（HR = 4.75；p = 0.041）。虽然手术边缘存在不良预后特征（多灶 PSM、PSM 长度≥ 3 mm、手术边缘 GG ≥ 4）会缩短无 BCR 生存期，但这些参数对 BCR 的影响均无统计学意义。研究发现，主肿瘤的格里森评分是 BCR 的较佳预后因素。

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来源期刊

African Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

1.00

自引率

0.00%

发文量

审稿时长

9 weeks