Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy
| Autor: | Robert Jeffrey Karnes, Stephen A. Boorjian, Matthew K. Tollefson, Laureano J. Rangel, Erik J. Bergstralh |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Oncology Biochemical recurrence Cancer Research medicine.medical_specialty Surgical margin Multivariate analysis Urology medicine.medical_treatment Kaplan-Meier Estimate Prostate cancer Risk Factors Internal medicine medicine Adjuvant therapy Humans Aged Neoplasm Staging Proportional Hazards Models Prostatectomy Proportional hazards model business.industry fungi Prostatic Neoplasms Middle Aged medicine.disease Tumor Burden Surgery Disease Progression Neoplasm Grading Neoplasm Recurrence Local Positive Surgical Margin business |
| Zdroj: | Prostate Cancer and Prostatic Diseases. 15:56-62 |
| ISSN: | 1476-5608 1365-7852 |
| DOI: | 10.1038/pcan.2011.36 |
| Popis: | BACKGROUND: Although a positive surgical margin (PSM) at radical prostatectomy (RRP) has been consistently linked to an increased risk of biochemical recurrence, the impact of margin status on patient survival continues to be debated. We evaluated long-term outcomes of patients with a PSM at RRP and determined predictors of systemic progression (SP) and mortality in these men. METHODS: We reviewed our institutional registry of 16749 patients who underwent RRP between 1990 and 2008 to identify 2895 patients with a PSM. Median follow-up was 10.6 years. Postoperative survival was estimated using the Kaplan–Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with SP and death from prostate cancer. RESULTS: A 15-year SP-free and cancer-specific survival was 90 and 93%, respectively. On multivariate analysis, higher tumor volume, increased pathological Gleason score and advanced pathological tumor stage were associated with significantly increased risks of SP and death from prostate cancer, whereas number and location of PSM did not predict mortality. CONCLUSIONS: The risks of SP and prostate cancer death in patients with a PSM remain low on long-term follow-up. Tumor variables are the primary determinants of cancer death. These results should be considered when evaluating patients with a PSM for adjuvant therapy. |
| Databáze: | OpenAIRE |
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