Prognostic impact of positive surgical margins in surgically treated prostate cancer: multi-institutional assessment of 5831 patients.
OBJECTIVE
To assess the prognostic significance of a positive surgical margin in the radical prostatectomy specimen, and to test for the presence of statistically significant interactions between surgical margin status and select pathologic stage variables.


METHODS
We combined prospectively collected data from 7816 consecutive patients treated with radical prostatectomy at eight institutions. The pretreatment serum prostate-specific antigen level, pathologic Gleason sum, surgical margin status (positive versus negative), presence of extracapsular extension, seminal vesicle involvement, and pelvic lymph node status were examined as predictors of the rate of biochemical progression in 5831 patients with complete records.


RESULTS
In multivariate Cox regression models, a positive surgical margin was associated with a 3.7-fold greater risk of progression (P = 0.001). Moreover, a statistically significant interaction was found between surgical margin status and Gleason sum 7 to 10 (P = 0.008) and lymph node invasion (P < 0.001).


CONCLUSIONS
The presence of a positive surgical margin in the radical prostatectomy specimen has an adverse effect on prognosis. The greatest risk of biochemical recurrence may be expected if a positive surgical margin is present with Gleason sum 7 to 10 disease or lymph node invasion.
Karakiewicz
Pierre I
PI
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. pierre.karakiewicz@umontreal.ca
Eastham
James A
JA
Graefen
Markus
M
Cagiannos
Ilias
I
Stricker
Phillip D
PD
Klein
Eric
E
Cangiano
Thomas
T
Schröder
Fritz H
FH
Scardino
Peter T
PT
Kattan
Michael W
MW
D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors