TY - JOUR
T1 - Biochemical recurrence after radical prostatectomy
T2 - Multiplicative interaction between surgical margin status and pathological stage
AU - Budäus, Lars
AU - Isbarn, Hendrik
AU - Eichelberg, Christian
AU - Lughezzani, Giovanni
AU - Sun, Maxine
AU - Perrotte, Paul
AU - Chun, Felix K H
AU - Salomon, Georg
AU - Steuber, Thomas
AU - Köllermann, Jens
AU - Sauter, Guido
AU - Ahyai, Sascha A.
AU - Zacharias, Mario
AU - Fisch, Margit
AU - Schlomm, Thorsten
AU - Haese, Alexander
AU - Heinzer, Hans
AU - Huland, Hartwig
AU - Montorsi, Francesco
AU - Graefen, Markus
AU - Karakiewicz, Pierre I.
PY - 2010/10
Y1 - 2010/10
N2 - Purpose A positive surgical margin after radical prostatectomy is considered an adverse prognostic feature. However, few groups have explored the potential interaction between surgical margin status and other cancer characteristics, specifically pathological stage. We addressed the first degree of interaction between positive surgical margins and other established adverse predictors of biochemical recurrence after radical prostatectomy. Materials and Methods We used univariate and multivariate analysis to test the effect of surgical margin status on biochemical recurrence in 4,490 patients treated at a single institution between 1992 and 2008. We systematically tested all first-degree interactions between surgical margin status, and pretreatment prostate specific antigen, pT and pN stage, and radical prostatectomy Gleason sum. If interactions were significant, we quantified the effect on the biochemical recurrence rate. Results Overall 850 patients (18.9%) had positive surgical margins. In those with negative vs positive surgical margins the 5-year biochemical recurrence-free survival rate was 95% vs 83%, 74% vs 62% and 47% vs 29% for pT2, pT3a and pT3b disease, respectively. In multivariate models only the pT stage-surgical margin status interaction achieved independent predictor status (p = 0.003). Negative vs positive surgical margin multivariate HRs were 1 vs 2.9, 2.3 vs 4.3 and 4.1 vs 5.6 in pT2, pT3a and pT3b cases, respectively. Conclusions Compared to negative surgical margins, positive surgical margins increase the absolute biochemical recurrence 5-year rate by 12% to 18%. More importantly, positive surgical margins may substantially worsen the prognosis beyond that of the original pathological disease stage.
AB - Purpose A positive surgical margin after radical prostatectomy is considered an adverse prognostic feature. However, few groups have explored the potential interaction between surgical margin status and other cancer characteristics, specifically pathological stage. We addressed the first degree of interaction between positive surgical margins and other established adverse predictors of biochemical recurrence after radical prostatectomy. Materials and Methods We used univariate and multivariate analysis to test the effect of surgical margin status on biochemical recurrence in 4,490 patients treated at a single institution between 1992 and 2008. We systematically tested all first-degree interactions between surgical margin status, and pretreatment prostate specific antigen, pT and pN stage, and radical prostatectomy Gleason sum. If interactions were significant, we quantified the effect on the biochemical recurrence rate. Results Overall 850 patients (18.9%) had positive surgical margins. In those with negative vs positive surgical margins the 5-year biochemical recurrence-free survival rate was 95% vs 83%, 74% vs 62% and 47% vs 29% for pT2, pT3a and pT3b disease, respectively. In multivariate models only the pT stage-surgical margin status interaction achieved independent predictor status (p = 0.003). Negative vs positive surgical margin multivariate HRs were 1 vs 2.9, 2.3 vs 4.3 and 4.1 vs 5.6 in pT2, pT3a and pT3b cases, respectively. Conclusions Compared to negative surgical margins, positive surgical margins increase the absolute biochemical recurrence 5-year rate by 12% to 18%. More importantly, positive surgical margins may substantially worsen the prognosis beyond that of the original pathological disease stage.
KW - pathology
KW - prostate
KW - prostate-specific antigen
KW - prostatectomy
KW - prostatic neoplasms
KW - surgical
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U2 - 10.1016/j.juro.2010.06.018
DO - 10.1016/j.juro.2010.06.018
M3 - Article
C2 - 20723925
AN - SCOPUS:79952984784
VL - 184
SP - 1341
EP - 1346
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 4
ER -