Impact of Positive Apical Surgical Margins on Likelihood of Biochemical Recurrence After Radical Prostatectomy
Impact of Positive Apical Surgical Margins on Likelihood of Biochemical Recurrence After Radical Prostatectomy
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DOI：
10.1016/j.juro.2009.08.054
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发表时间：
2009-12-01
影响因子：
6.6
通讯作者：
Barocas, Daniel A.
中科院分区：
文献类型：
--
作者：
Kordan, Yakup;Salem, Shady;Barocas, Daniel A.
目的：我们评估根尖部手术切缘阳性是否会导致生化复发的可能性与其他部位不同。材料和方法：2000 年 1 月至 2008 年 6 月期间，共有 3,087 名男性接受了根治性前列腺切除术。之前接受过治疗、精囊阳性、淋巴结受累或随访时间少于 6 个月的患者被排除在分析之外。其余 1,667 名男性按切缘状态分组，包括手术切缘阴性、根尖切缘阳性、孤立非根尖切缘阳性和多处切缘阳性。 Kaplan-Meier 分析用于比较各组之间的生化复发情况。构建 Cox 比例风险模型以确定孤立的根尖缘阳性是否是生化复发的独立危险因素。结果：中位随访时间为 21.1 个月。在这些病例中，1,295 例（77.7%）手术切缘呈阴性，96 例（5.8%）呈单发阳性切缘，82 例（4.9%）呈单发非根尖切缘阳性，194 例（11.6%）呈多处阳性切缘。孤立阳性根尖边缘病例的生化复发可能性介于阴性手术边缘和孤立阳性非根尖边缘之间，其中多个阳性边缘显示生化复发的可能性最高（p
Purpose: We evaluated whether a positive surgical margin at the apex confers a different likelihood of biochemical recurrence than at other sites.Material and Methods: A total of 3,087 men underwent radical prostatectomy between January 2000 and June 2008. Patients with prior treatment, positive seminal vesicles, lymph node involvement or less than 6 months of followup were excluded from analysis. The remaining 1,667 men were grouped by margin status, including negative surgical margins, a solitary positive apical margin, a solitary nonapical positive margin and multiple positive margins. Kaplan-Meier analysis was used to compare biochemical recurrence across groups. Cox proportional hazards models were constructed to determine whether a solitary positive apical margin is an independent risk factor for biochemical recurrence.Results: Median followup was 21.1 months. Of the cases 1,295 (77.7%) had negative surgical margins, 96 (5.8%) had a solitary positive apical margin, 82 (4.9%) had a solitary positive nonapical margin and 194 (11.6%) had multiple positive margins. The likelihood of biochemical recurrence in solitary positive apical margin cases was between that of negative surgical margins and a solitary positive nonapical margin with multiple positive margins showing the highest likelihood of biochemical recurrence (p