Prognostic value of unifocal and multifocal positive surgical margins in a large series of robot-assisted radical prostatectomy for prostate cancer
To evaluate the prognostic value of positive surgical margins (PSM) focality for the prediction of biochemical recurrence (BCR) in patients undergoing robotic-assisted radical prostatectomy (RARP) for prostate cancer.
All men with clinically localized prostate cancer undergoing RARP in our tertiary referral centre between May 2005 and August 2016 were retrospectively identified. Patients with neoadjuvant therapy were excluded. Comparisons were made between cases with negative surgical margins (NSM), unifocal PSM (uPSM), and multifocal PSM (mPSM).
From a total of 973 patients available for analysis, 315 (32%) had a PSM. In these patients, 190 had uPSM and 125 had mPSM. Focality of PSM was significantly associated with tumour stage and grade, preoperative PSA, and postoperative PSA persistence (all p < 0.001), but not with nerve sparing (NS) (p = 0.15). PSA persistence was found in 120 (12%) patients, resulting in 853 patients available for survival analyses with a median follow-up of 52 months. Both uPSM and mPSM were found to be independent predictors of BCR, conferring a hazard ratio of 1.9 (95% CI 1.3–3.0; p = 0.002) and 3.4 (95% CI 2.1–5.6; p < 0.001), respectively, when compared to NSM. In subgroup analyses, PSM was particularly predictive for BCR when patients underwent unilateral or bilateral NS (p ≤ 0.003).
Based on a large case series of RARP, we found PSM focality to be an independent predictor of BCR, with a 1.9- and 3.4-fold risk increase for BCR in case of uPSM and mPSM, respectively. PSM seems to be of particular prognostic relevance when NS has been performed.
KeywordsProstate cancer Radical prostatectomy Surgical margins Focality Prognosis Biochemical recurrence
EXK protocol/project development, data collection or management, data analysis, and manuscript writing/editing. JB data collection or management, and manuscript writing/editing. AJB data collection or management, and manuscript writing/editing. KS data collection or management, data analysis, and manuscript writing/editing. AM data collection or management, data analysis, and manuscript writing/editing. BK data collection or management, and manuscript writing/editing. CDF data collection or management, data analysis, and manuscript writing/editing. PW protocol/project development, data analysis, and manuscript writing/editing. TS protocol/project development, data analysis, and manuscript writing/editing. TH protocol/project development, data analysis, and manuscript writing/editing. DE protocol/project development, data analysis, and manuscript writing/editing. CP protocol/project development, data collection or management, data analysis, and manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
The authors disclose no potential conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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