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Focal positive surgical margins decrease disease-free survival after radical prostatectomy even in organ-confined
Alison M Lake1, Chang He, David P Wood
1Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA. alilake@med.umich.edu
Urology
|January 30, 2010
Summary
Focal positive margins (FPM) after prostatectomy significantly decrease disease-free survival (DFS), even in organ-confined cases. This finding highlights the importance of margin status in predicting prostate cancer recurrence.
Area of Science:
- Urology
- Oncology
- Surgical Pathology
Background:
- The clinical significance of focal positive margins (FPM) after radical prostatectomy remains uncertain.
- It is hypothesized that FPM may be artifacts and not indicative of true tumor spread, thus not impacting disease-free survival (DFS).
Purpose of the Study:
- To investigate the prognostic significance of focal positive margins (FPM) in patients following radical prostatectomy.
- To determine if FPM impacts disease-free survival (DFS) in prostatectomy patients.
Main Methods:
- Retrospective review of 2468 radical prostatectomy cases (1996-2008).
- Comparison of DFS probabilities using log-rank test for negative margins (NM), FPM (≤3 mm), and extensively positive margins (EPM) (>3 mm).
- Multivariate Cox analysis to assess FPM significance in prostate cancer.
Main Results:
- FPM were identified in 14% of patients, EPM in 4%.
- 10-year DFS was significantly lower for FPM (64%) and EPM (38%) compared to NM (84%) (P < .0001).
- DFS reduction associated with positive margins persisted even in organ-confined disease, and recurrence risk correlated with margin status and Gleason grade.
Conclusions:
- Focal positive margins and extensively positive margins after radical prostatectomy are associated with decreased disease-free survival.
- These findings underscore the prognostic importance of margin status, even in cases of organ-confined prostate cancer.
