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Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality

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Abstract

Purpose

We investigated the influence of positive surgical margins (PSMs) and their locations on biochemical recurrence (BCR) according to risk stratification and surgical modality.

Methods

A total of 1,874 post-radical-prostatectomy (RP) patients of pT2–T3a between 2000 and 2010 at three tertiary centers, and who did not receive neoadjuvant/adjuvant therapy, were included in this study. Patients were stratified according to BCR risk: low risk (PSA <10, pT2a-b, and pGS ≤6), intermediate risk (PSA 10–20 and/or pT2c and/or pGS 7), and high risk (PSA >20 or pT3a or pGS 8–10). The median follow-up was 43 months.

Results

PSMs were a significant predictor of BCR in both the intermediate- and high-risk-disease groups (P = .001, HR 2.1, 95 % CI 1.3–3.4; P < .001, HR 2.8, 95 % CI 2.0–4.1). Positive apical margin was a significant risk factor for BCR in high-risk disease (P = .003, HR 2.0, 95 % CI 1.2–3.3), but not in intermediate-risk disease (P = .06, HR 1.7, 95 % CI 0.9–3.1). Positive bladder neck margin was a significant risk factor for BCR in both intermediate- and high-risk disease (P < .001, HR 5.4, 95 % CI 2.1–13.8; P = .001, HR 4.5, 95 % CI 1.8–11.4). In subgroup analyses, robotic RP provided comparable BCR-free survival regardless of risk stratification. Patients with PSMs showed similar BCR-free survival between open and robotic RP (log-rank, P = .897).

Conclusions

Post-RP PSMs were a significantly independent predictor of disease progression in high-risk disease as well as intermediate-risk disease. Both positive apical and bladder neck margins are also significant risk factors of BCR in high-risk disease. Patients with PSMs showed similar BCR-free survival between open and robotic surgery.

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Authors and Affiliations

  1. Department of Urology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Min Soo Choo, Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak & Hyeon Hoe Kim

  2. Department of Urology, Seoul National University Boramae Hospital, Sindaebang 2-dong, 395, Dongjak-gu, Seoul, 156-707, Korea

    Sung Yong Cho, Seung Bae Lee & Hyeon Jeong

  3. Department of Urology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangding-gu, Seoul, 134-701, Korea

    Kyungtae Ko

  4. Department of Urology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seongnam, 463-707, Korea

    Sung Kyu Hong, Seok-Soo Byun & Sang Eun Lee

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  1. Min Soo Choo
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Correspondence to Hyeon Jeong.

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Choo, M.S., Cho, S.Y., Ko, K. et al. Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality. World J Urol 32, 1401–1409 (2014). https://doi.org/10.1007/s00345-013-1230-0

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  • DOI: https://doi.org/10.1007/s00345-013-1230-0

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