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首页> 外文期刊>BJU international >Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression?
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Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression?

机译：前列腺癌根治术后手术切缘阳性：它们对生化或临床进展有影响吗？

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OBJECTIVE: To prospectively examine the effects of the margin status after radical prostatectomy (RP), the location, and the number of positive surgical margins (PSMs) on biochemical and clinical outcome, as even if there seems to be little debate that there is a higher risk of both local and distant recurrence of prostate cancer in the face of a PSM the significance of a PSM after RP is only followed for biochemical progression in most studies. PATIENTS AND METHODS: From our prospective database, 406 consecutive well-described patients without neoadjuvant and 'direct postoperative' adjuvant therapy who underwent RP were included. The median age was 64.7 years, the median preoperative PSA level was 7.9 ng/mL, and the median follow-up was 5.2 years. We analysed pathological tumour stage, grading, number and location of PSMs, PSA-free survival, local recurrence-free survival, metastasis-free survival, prostate cancer-specific and, overall survival prospectively. RESULTS: The overall rate of PSMs was 17.2%. The number was higher in higher stage (P < 0.001) and higher grade tumours (P = 0.041). For a PSM the PSA recurrence rate was 64.3%, the local recurrence rate was 18.6%, the development of distant metastasis was 15.7% and therefore much higher than in patients with negative margins (20.5%, 2.7%, and 1.5%). A PSM was an adverse predictor for PSA-free survival (P < 0.001), local recurrence-free survival (P = 0.002), and development of metastasis (P = 0.003) on multivariate analysis. The number and location of PSMs was of no additional prognostic value. CONCLUSIONS: A PSM increases the risk of biochemical and clinical e.g. local, disease progression after RP. The number and location of PSMs is of minor importance. Although only approximately 20% of patients with a PSM will develop local recurrence, surgeons should continue to strive to reduce the rate of PSMs to improve cancer control.
机译：目的：前瞻性检查根治性前列腺切除术（RP）后的切缘状态，位置和阳性切缘数量（PSMs）对生化和临床结果的影响，即使似乎很少有人争论面对PSM，前列腺癌局部和远处复发的风险均较高。在大多数研究中，仅针对生化进展追踪RP后PSM的意义。患者和方法：从我们的前瞻性数据库中，纳入了406例接受RP连续描述的，无新辅助治疗和“术后直接”辅助治疗的患者。中位年龄为64.7岁，中位术前PSA水平为7.9 ng / mL，中位随访时间为5。2年。我们分析了病理肿瘤的阶段，PSM的等级，数量和位置，无PSA的生存期，无局部复发的生存期，无转移的生存期，特定于前列腺癌的生存期以及总体生存期。结果：PSM的总发生率为17.2％。在更高阶段（P <0.001）和更高等级的肿瘤（P = 0.041），该数目更高。对于PSM，PSA复发率为64.3％，局部复发率为18.6％，远处转移的发生率为15.7％，因此远高于边缘阴性的患者（20.5％，2.7％和1.5％）。 PSM是多因素分析中无PSA生存（P <0.001），无局部复发生存（P = 0.002）和转移发生（P = 0.003）的不良预测指标。 PSM的数量和位置没有附加的预后价值。结论：PSM增加了生化和临床风险，例如局部，RP后疾病进展。 PSM的数量和位置不太重要。尽管只有约20％的PSM患者会出现局部复发，但外科医生应继续努力降低PSM的发生率，以改善癌症控制。

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