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首页> 外文期刊>BJU international >Positive surgical margins: Rate, contributing factors and impact on further treatment: Findings from the Prostate Cancer Registry
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Positive surgical margins: Rate, contributing factors and impact on further treatment: Findings from the Prostate Cancer Registry

机译：手术切缘阳性：比率，影响因素和对进一步治疗的影响：前列腺癌登记处的发现

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Objective To describe the characteristics of patients with and without positive surgical margins (PSMs) and to analyse the impact of PSMs on secondary cancer treatment after radical prostatectomy (RP), with short-term follow-up. Patients and Methods We analysed data from 2385 consecutive patients treated using RP, who were notified to the Prostate Cancer Registry by 37 hospitals in Victoria, Australia between August 2008 and February 2012. Independent and multivariate models were constructed to predict the likelihood of PSMs. Independent and multivariate predictors of secondary treatment after RP in the initial 12 months after diagnosis were also assessed. Results Data on PSM status were collected for 2219/2385 (93%) patients. In total 592/2175 (27.2%) RPs resulted in PSMs; 102/534 (19.1%) in the low-risk group, 317/1218 (26.0%) in the intermediate-risk group, 153/387 (39.5%) in the high-risk group, and 9/11 (81.8%) in the very-high-risk disease group of patients. Patients having surgery in a hospital where <10 RPs occur each year were significantly more likely to have a PSM (incidence rate ratio [IRR] 1.44, 95% confidence interval [CI] 1.07-1.93) and those in the intermediate-, high- or very-high-risk groups (IRR 1.34, 95% CI 1.09-1.65, P = 0.007, IRR 1.96, 95% CI 1.57-2.45, P < 0.001 and IRR 3.81, 95% CI 2.60-5.60, P < 0.001, respectively) were significantly more likely to have a PSM than those in the low-risk group (IRR 2.50, 95% CI 1.23-5.11, P = 0.012). Patients with PSMs were significantly less likely to have been treated at a private hospital than a public hospital (IRR 0.76, 95% CI 0.63-0.93, P = 0.006) or to have undergone robot-assisted RP (IRR 0.69, 95% CI 0.55-0.87; P = 0.002) than open RP. Of the 2182 patients who underwent RP in the initial 12 months after diagnosis, 1987 (91.1%) received no subsequent treatment, 123 (5.6%) received radiotherapy, 47 (2.1%) received androgen deprivation therapy (ADT) and 23 (1.1%) received a combination of radiotherapy and ADT. Two patients (0.1%) received chemotherapy combined with another treatment. At a multivariate level, predictors of additional treatment after RP in the initial 12 months included having a PSM compared with a negative surgical margin (odds ratio [OR] 5.61, 95% CI 3.82-8.22, P < 0.001); pT3 compared with pT2 disease (OR 4.72, 95% CI 2.69-8.23, P < 0.001); and having high- or very-high-risk disease compared with low-risk disease (OR 4.36, 95% CI 2.24-8.50, P < 0.001 and OR 4.50, 95% CI 1.34-15.17, P = 0.015, respectively). Patient age, hospital location and hospital type were not associated with secondary treatment. Patients undergoing robot-assisted RP were significantly less likely to receive additional treatment than those receiving open RP (OR 0.59, 95% CI 0.39-0.88, P = 0.010). Conclusions These data indicate an important association between hospital status and PSMs, with patients who underwent RP in private hospitals less likely than those in public hospitals to have a PSM. Patients treated in lower-volume hospitals were more likely to have a PSM and less likely to receive additional treatment after surgery in the initial 12 months, and robot-assisted RP was associated with fewer PSMs than was open RP in this non-randomized observational study. PSM status and pathological T3 disease are both important and independent predictors of secondary cancer treatment for patients undergoing RP. A robot-assisted RP approach appears to decrease the likelihood of subsequent treatment, when compared with the open approach.
机译：目的描述具有和不具有阳性手术切缘（PSM）的患者的特征，并分析PSM对根治性前列腺切除术（RP）后继发性癌症治疗的影响，并进行短期随访。患者和方法我们分析了2008年8月至2012年2月间澳大利亚维多利亚州的37家医院通知前列腺癌登记处的2385例接受RP治疗的连续患者的数据。构建了独立和多变量模型来预测PSM的可能性。在诊断后的最初12个月中，还评估了RP后二次治疗的独立和多因素预测因素。结果收集了2219/2385（93％）患者的PSM状态数据。共有592/2175个（27.2％）RP导致了PSM;低危组102/534（19.1％），中危组317/1218（26.0％），高危组153/387（39.5％）和9/11（81.8％）在极高风险的疾病组中。每年在医院中进行<10 RP手术的患者发生PSM的可能性更高（发生率[IRR] 1.44，95％置信区间[CI] 1.07-1.93），而处于中，高，或非常高风险的人群（IRR 1.34，95％CI 1.09-1.65，P = 0.007，IRR 1.96，95％CI 1.57-2.45，P <0.001和IRR 3.81，95％CI 2.60-5.60，P <0.001，与低风险组相比，分别具有更高的PSM可能性（IRR 2.50，95％CI 1.23-5.11，P = 0.012）。 PSM患者在公立医院接受治疗的可能性明显低于公立医院（IRR 0.76，95％CI 0.63-0.93，P = 0.006）或接受机器人辅助RP的可能性（IRR 0.69，95％CI 0.55） -0.87; P = 0.002）。在诊断后最初12个月接受RP的2182例患者中，1987年（91.1％）没有接受任何后续治疗，123例（5.6％）接受了放射治疗，47例（2.1％）接受了雄激素剥夺疗法（ADT），23例（1.1％） ）接受了放疗和ADT的联合治疗。两名患者（0.1％）接受了化学疗法联合另一种治疗。在多变量水平上，预测在最初12个月进行RP后需要额外治疗的预测因素包括PSM与手术切缘阴性相比（赔率[OR] 5.61，95％CI 3.82-8.22，P <0.001）; pT3与pT2疾病相比（OR 4.72，95％CI 2.69-8.23，P <0.001）;与低风险疾病相比具有高或极高风险的疾病（分别为OR 4.36、95％CI 2.24-8.50，P <0.001和OR 4.50、95％CI 1.34-15.17，P = 0.015）。患者年龄，医院位置和医院类型与二级治疗无关。与接受开放式RP的患者相比，接受机器人辅助RP的患者接受其他治疗的可能性明显更低（OR 0.59，95％CI 0.39-0.88，P = 0.010）。结论这些数据表明，医院状况和PSM之间存在重要的联系，在私立医院接受RP的患者比在公立医院接受RP的患者更少。在此非随机观察性研究中，在较小规模的医院中接受治疗的患者在最初的12个月内更有可能患有PSM，并且在手术后接受其他治疗的可能性也较小，并且与开放RP相比，机器人辅助RP的PSM更少。 PSM状况和病理性T3疾病是接受RP的患者继发癌症治疗的重要独立指标。与开放式方法相比，机器人辅助的RP方法似乎减少了后续治疗的可能性。

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