When Should a Positive Surgical Margin Ring a Bell? An Analysis of a Multi-Institutional Robot-Assisted Laparoscopic Radical Prostatectomy Database

Firas Abdollah; Marco Moschini; Akshay Sood; Jesse Sammon; Deepansh Dalela; Linda Hsu; Burkhard Beyer; Alexander Haese; Markus Graefen; Giorgio Gandaglia; Francesco Montorsi; Alberto Briganti; Mani Menon

doi:10.1089/end.2015.0465

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When Should a Positive Surgical Margin Ring a Bell? An Analysis of a Multi-Institutional Robot-Assisted Laparoscopic Radical Prostatectomy Database

Journal article

Peer reviewed

When Should a Positive Surgical Margin Ring a Bell? An Analysis of a Multi-Institutional Robot-Assisted Laparoscopic Radical Prostatectomy Database

Firas Abdollah, Marco Moschini, Akshay Sood, Jesse Sammon, Deepansh Dalela, Linda Hsu, Burkhard Beyer, Alexander Haese, Markus Graefen, Giorgio Gandaglia, …

Journal of endourology, Vol.30(2), pp.201-207

02/2016

DOI: 10.1089/end.2015.0465

PMID: 26415003

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Abstract

The impact of positive surgical margin (SM) on cancer control outcomes in prostate cancer patients is a subject of continuous debate. We test the hypothesis that the impact of SM on clinical recurrence (CR) rate may vary based on the other clinical/pathologic characteristics of the tumor. We focused on 5290 patients treated with robot-assisted radical prostatectomy and pelvic node dissection, between 2002 and 2013, at three tertiary care centers. Regression tree analysis stratified patients into risk groups based on their tumor characteristics and the corresponding CR rate. Kaplan-Meier log-rank and multivariable Cox regression models tested the relationship between SM status and CR rate in each tree-generated risk group. Mean (median) follow-up time was 47.7 (39.0) months. Regression tree analysis that considered all available covariates, except SM status, divided patients based on their CR risk into the following risk groups: (1) high risk (any pT3b/pT4 disease); (2) intermediate risk (≤pT3a disease and pGS 8-10); (3) low risk (≤pT3a, pGS ≤7, and prostate-specific antigen [PSA] >9 ng/mL); and (4) very low risk (≤pT3a, pGS ≤7, and PSA ≤9 ng/mL). Positive SM had a significant detrimental impact on CR risk only in two groups: intermediate risk (p < 0.001) and high risk (p = 0.01). These observations were confirmed by multivariable analyses. Our findings show that positive SM had a detrimental impact on CR only in a minority of patients (15%), specifically in those with advanced pathologic stage and/or pathologically poorly differentiated tumor. For all the remaining patients (85%), positive SM by itself did not increase the risk of CR.

Aged

Chemotherapy, Adjuvant

Databases, Factual

Disease-Free Survival

Humans

Kaplan-Meier Estimate

Laparoscopy

Lymph Node Excision

Lymph Nodes - pathology

Male

Middle Aged

Multivariate Analysis

Neoplasm Grading

Neoplasm Recurrence, Local - blood

Neoplasm Recurrence, Local - epidemiology

Neoplasm Staging

Neoplasm, Residual

Pelvis

Proportional Hazards Models

Prostate-Specific Antigen - blood

Prostatectomy

Prostatic Neoplasms - blood

Prostatic Neoplasms - pathology

Prostatic Neoplasms - surgery

Radiotherapy, Adjuvant

Retrospective Studies

Risk Factors

Robotic Surgical Procedures

Details

Title: Subtitle: When Should a Positive Surgical Margin Ring a Bell? An Analysis of a Multi-Institutional Robot-Assisted Laparoscopic Radical Prostatectomy Database
Creators: Firas Abdollah - Henry Ford Health System
Marco Moschini - Vita-Salute San Raffaele University
Akshay Sood - Henry Ford Health System
Jesse Sammon - Henry Ford Health System
Deepansh Dalela - Henry Ford Health System
Linda Hsu - Henry Ford Health System
Burkhard Beyer - Universität Hamburg
Alexander Haese - Martini-Klinik
Markus Graefen - Martini-Klinik
Giorgio Gandaglia - Vita-Salute San Raffaele University
Francesco Montorsi - Vita-Salute San Raffaele University
Alberto Briganti - Vita-Salute San Raffaele University
Mani Menon - Henry Ford Health System
Resource Type: Journal article
Publication Details: Journal of endourology, Vol.30(2), pp.201-207
DOI: 10.1089/end.2015.0465
PMID: 26415003
NLM abbreviation: J Endourol
ISSN: 0892-7790
eISSN: 1557-900X
Language: English
Date published: 02/2016
Academic Unit: Urology
Record Identifier: 9984949203002771

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