Objectives
To assess whether reporting the grade of cancer at the site of positive margins in
a radical prostatectomy (RP) specimen was independently prognostic of the outcome.
Methods
We restricted our study to 108 patients with Gleason score (GS) 7, nonfocal extraprostatic
extension (EPE) (Stage pT3a), and positive surgical margins. Patients with a tertiary
pattern 5, those who had received neoadjuvant therapy, and those with positive margins
because of an intraprostatic incision were excluded.
Results
The overall GS was 3 + 4 in 73 patients (67%) and 4 + 3 in 35 (33%). The median length
of the positive margin was 3.0 mm (range 0.5-10). The GS at the margin was 3 + 3,
3 + 4, 4 + 3, and 4 + 4 in 40 (37%), 41 (38%), 16 (14.8%), and 11 (10.2%) cases, respectively.
Of the 108 patients, 45 (42%) remained free of disease after RP (median follow-up
6 years, range 3-13). Univariate and multivariate analyses showed no correlation between
biochemical recurrence and either the preoperative serum prostate-specific antigen
level (P = .7) or overall GS (P = .5). A strong association was noted between biochemical recurrence and the GS at
the positive surgical margin (P = .007), with length of cancer at the margin also predictive (P = .015) on multivariate analysis. Using the median length of the positive margin
(3 mm) as the cutoff, the association with biochemical recurrence was significantly
different between the 2 groups (P = .004) using Kaplan-Meier analysis.
Conclusions
This is the first study to show that the grade of cancer at the site of a positive
margin influences the outcome. We were able to stratify the grade into 3 categories:
3 + 3, 3 + 4, and 4 + 3 or greater (4 + 3 and 4 + 4 at the positive margin provided
equal prognostic information).
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Article info
Publication history
Published online: August 09, 2010
Accepted:
March 4,
2010
Received:
January 4,
2010
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Editorial CommentUrologyVol. 76Issue 5
- PreviewPositive surgical margins and their relevance in predicting biochemical recurrence (BCR) is currently a “hot” topic in urology studies. Recent publications have suggested that more detailed annotation of the pathologic parameters related to a positive margin might provide additional prognostic information. Brimo et al1 are the first to highlight an association between the Gleason score at a positive surgical margin and BCR in 108 patients with an overall Gleason score of 7, extraprostatic extension (EPE), and margin positivity.
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