A Contemporary Analysis of Positive Surgical Margin Length and Oncologic Outcomes After Radical Prostatectomy: Results from an Institutional Registry with Long-Term Follow Up.

IF 2.3 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2026-10-15 DOI:10.1016/j.urology.2026.10.004

Chloe Shi, Eric V Li, Michael K Wang, Jamie O'Byrne, Peter Galatowitsch, Igor Frank, Matthew K Tollefson, Vidit Sharma, Paras Shah, Matthew T Gettman, R Jeffrey Karnes, Stephen A Boorjian, Abhinav Khanna

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引用次数: 0

Abstract

Objective: To evaluate the impact of positive surgical margins (PSM) after radical prostatectomy (RP) and oncologic outcomes in a large institutional registry with long-term follow up and explore various methods of margin characterization. Prior studies remain limited by heterogeneous margin characterization, small cohorts, and limited follow-up.

Methods: We queried our prospectively maintained institutional registry for patients who underwent RP from 1987-2023. PSM were analyzed as binary (negative/positive) and focality (negative/unifocal/multifocal). Cox proportional hazards regression models evaluated associations with oncologic outcomes. Cutpoint analysis identified an optimal threshold that differentiated outcomes by linear PSM length.

Results: Among 24,855 patients with median follow-up of 10.9 years, 6454(26%) had PSM. On multivariable analysis, PSM were associated with increased risk of biochemical recurrence (BCR, HR 1.74 [1.57-1.93], p<.0001), but not metastasis-free (MFS), cancer-specific (CSS), or overall survival (OS). Unifocal (HR 1.66 [1.48-1.86]) and multifocal (HR 2.01 [1.7-2.37]) PSM were similarly associated with increased risk of BCR (p<.0001), but not MFS, CSS, or OS. Cutpoint analysis identified a threshold of 1mm. PSM length ≥1mm was associated with increased risk of BCR (HR 1.72[1.53-1.92, p<.0001), while <1mm was not.

Conclusions: In this large cohort with long-term follow-up, PSMs were only associated with BCR but not with MFS, CSS, or OS. These results may inform postoperative surveillance protocols and adjuvant therapy risk stratification. Additionally, on exploratory analyses in a small subgroup of men with limited follow-up duration, PSMs shorter than 1mm did not appear to be associated with BCR, a hypothesis-generating finding which warrants further investigation in the modern era of digitized pathology.

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来源期刊

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.