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Prognostic value of unifocal and multifocal positive surgical margins in a large series of robot-assisted radical prostatectomy for prostate cancer

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Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Etienne Xavier Keller, Jacqueline Bachofner, Anna Jelena Britschgi, Karim Saba, Ashkan Mortezavi, Basil Kaufmann, Christian D. Fankhauser, Tullio Sulser, Thomas Hermanns, Daniel Eberli & Cédric Poyet

  2. Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Peter Wild

  3. Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Peter Wild

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  1. Etienne Xavier Keller
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  2. Jacqueline Bachofner
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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.

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Correspondence to Cédric Poyet.

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Keller, E.X., Bachofner, J., Britschgi, A.J. et al. Prognostic value of unifocal and multifocal positive surgical margins in a large series of robot-assisted radical prostatectomy for prostate cancer. World J Urol 37, 1837–1844 (2019). https://doi.org/10.1007/s00345-018-2578-y

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