Positive surgical margin in robot-assisted radical prostatectomy: correlation with pathology findings and risk of biochemical recurrence
Positive surgical margin in robot-assisted radical prostatectomy: correlation with pathology findings and risk of biochemical recurrence
复制标题
DOI：
10.23736/s0393-2249.17.02707-2
复制
发表时间：
2017-10-01
影响因子：
--
通讯作者：
Lee, Sang-Eun
中科院分区：
文献类型：
--
作者：
Jo, Jung-Ki;Hong, Sung-Kyu;Lee, Sang-Eun
背景技术背景：分析手术切缘状态与接受机器人辅助根治性前列腺切除术（RALP）患者的最终病理学和生化复发风险（BCR）的其他结果的相关性。方法：回顾Bundang前列腺切除术数据库，以确定2007年至2011年接受RARP并在最终病理学上具有阳性手术切缘（PSM）的患者。对病理学结果进行了审查。使用Kaplan-Meier方法计算无BCR生存期。结果：815例患者中，根尖切缘阳性118例（14.48%），其他部位切缘阳性152例（18.65%），手术切缘阴性545例（66.87%）。在仅有心尖部PSM的患者中，按临床分期分层，Kaplan-Meier分析显示两组间无BCR生存率存在显著差异（对数秩P< 0.001）。多因素考克斯比例风险模型显示，核心抗体阳性率最大是BCR的最强预测因子（HR=3.131，P< 0.001）。多因素考克斯比例风险模型显示PSM是术后BCR的有效预测因子之一（HR= 3.123，P< 0.001）。最大阳性核心百分比是术前BCR最有力的预测因素。临床分期和活检Gleason评分也与仅根尖切缘阳性患者的病理结局和无BCR生存率相关。
BACKGROUND: To analyze the correlation of surgical margin status with other findings on final pathology and risk of biochemical recurrence (BCR) in patients undergoing robot-assisted radical prostatectomy (RALP).METHODS: Bundang Prostatectomy Database was reviewed to identify patients who underwent RARP from 2007 to 2011 and had a positive surgical margin (PSM) on final pathology. Pathology findings were reviewed. BCR-free survival was calculated using the Kaplan-Meier method. Cox univariable and multi-variable regression models were used to find the correlation between clinicopathologic factors and BCR.RESULTS: Eight hundred and fifteen patients were included in the analysis: 118 (14.48%) had apical positive margin, 152 (18.65%) had a positive margin in another site, and 545 (66.87%) had negative surgical margins. In patients with only apical PSM, stratified by clinical stage, Kaplan-Meier analysis demonstrated significant difference in BCR-free survival between the groups (log rank P< 0.001). Multivariable Cox proportional hazards model showed maximal percentage of positive core is the strongest predictor of BCR (HR=3.131, P< 0.001). Multivariable Cox proportional hazards model showed PSM is one of the powerful predictor of postoperative BCR (HR= 3.123, P< 0.001).CONCLUSIONS: PSM after RALP is one of the powerful predictor of BCR and apical PSM is relatively less powerful predictor of BCR. Maximal percentage of positive core is the most powerful preoperative predictors of BCR. Clinical stage and biopsy Gleason score are also associated with pathologic outcomes and BCR free survival rates in patients with positive apical margin only.