Abstract
Objectives
To assess the prognostic significance of a positive surgical margin in the radical
prostatectomy specimen, and to test for the presence of statistically significant
interactions between surgical margin status and select pathologic stage variables.
Methods
We combined prospectively collected data from 7816 consecutive patients treated with
radical prostatectomy at eight institutions. The pretreatment serum prostate-specific
antigen level, pathologic Gleason sum, surgical margin status (positive versus negative),
presence of extracapsular extension, seminal vesicle involvement, and pelvic lymph
node status were examined as predictors of the rate of biochemical progression in
5831 patients with complete records.
Results
In multivariate Cox regression models, a positive surgical margin was associated with
a 3.7-fold greater risk of progression (P = 0.001). Moreover, a statistically significant interaction was found between surgical
margin status and Gleason sum 7 to 10 (P = 0.008) and lymph node invasion (P <0.001).
Conclusions
The presence of a positive surgical margin in the radical prostatectomy specimen has
an adverse effect on prognosis. The greatest risk of biochemical recurrence may be
expected if a positive surgical margin is present with Gleason sum 7 to 10 disease
or lymph node invasion.
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Article info
Publication history
Accepted:
June 22,
2005
Received:
September 3,
2004
Footnotes
This research was supported by grants from the American Cancer Society (RPG-00-202-01-CCE), Deutsche Forschungsgemeinschaft (GR 1866/1-1) and Deutsche Krebshilfe, National Health and Medical Research Council of Australia (NHMRC), New South Wales Cancer Council, the R. T. Hall Trust, Freedman Foundation, St. Vincent’s Clinic Foundation and St. Vincent’s Hospital Foundation. P. I. Karakiewicz was partially supported by the American Foundation for Urologic Diseases, the National Cancer Institute of Canada, and the Medical Research Council of Canada.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
