[Radical prostatectomy in clinically localized prostatic adenocarcinoma. Study of patients with positive margins and their impact on survival free from biochemical progression].
OBJECTIVE
Margins involvement in T1-T2 patients undergoing radical prostatectomy is a negative prognostic factor. We aimed to: a) Study the clinical and pathological features of patients with surgical margins involvement; b) Elucidate the influence of margins involvement on the progression-free survival.


METHODS
The study included the group with "positive margins" out of a series of 160 patients with localised prostate adenocarcinoma who underwent radical prostatectomy at the Clínica Universitaria de Navarra between 1988-1997. statistics used: Fisher's or Pearson's test for qualitative variables. Kaplan-Meyer, Log-rank and Cox's multivariate tests for the survival study.


RESULTS
The group accounts for 28% (45/158) of all patients undergoing radical prostatectomy. Mean PSA (22 +/- 14 ng/ml) is similar to the remaining group although there is greater significant rates of PSA > 15 ng/ml (p: 0.006), worse Gleason (p: 0.01), higher proportion of T2bc (p: 0.003) and node involvement (0.001). Progression-free survival (BPFS) is significantly lower in this group (32 +/- 12% vs 61 +/- 6% at 5 years). Margins are the single factor with higher influence (RR:5) in the multivariate study. Influence is clear in patients with Gleason < 5 (0% vs 87%) and PSA < 30 ng/ml (33 +/- 14 vs 70 +/- 7%), but has no influence on BPFS of patients with PSA > 30 ng/ml or Gleason 5-10.


CONCLUSIONS
Positive margins in patients undergoing radical prostatectomy is associated to higher PSA, worse Gleason and higher stage. They are the most significant independent risk factor (except for PSA > 30 ng/ml) for biochemical progression-free survival as evidenced in the multivariate study, although it is likely this influence is diluted in patients with PSA > 30 ng/ml and/or Gleason 5-10.
Zudaire Bergera
J J
JJ
Departamento de Urología, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona.
Martín-Marquina Aspiunza
A
A
Sánchez Zalabardo
D
D
Arocena García-Tapia
J
J
Sanz Pérez
G
G
Diez Caballero
F
F
Rosell Costa
D
D
Robles García
J E
JE
Berián Polo
J M
JM
D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
D017430:Prostate-Specific Antigen