title: Impact of pathology review of stage and margin status of radical prostatectomy specimens (EORTC trial 22911).
abstract: Pathological staging and surgical margin status of radical prostatectomy specimens are next to grading the most important prognosticators for recurrence. A central review of pathological stage and surgical margin status was performed on a series of 552 radical prostatectomy specimens of patients, participating in the European Organisation for Research and Treatment of Cancer trial 22911. Inclusion criteria of the trial were pathological stage pT3 and/or positive surgical margin at local pathology. All specimens were totally embedded. Data of the central review were compared with those of local pathologists and related to clinical follow-up. Although a high concordance between review pathology and local pathologists existed for seminal vesicle invasion (94%, kappa=0.83), agreement was much less for extraprostatic extension (57.5%, kappa=0.33) and for surgical margin status (69.4%, kappa=0.45). Review pathology of surgical margin status was a stronger predictor of biochemical progression-free survival in univariate analysis [hazard ratio (HR)=2.16 and p=0.0002] than local pathology (HR=1.08 and p>0.1). The review pathology demonstrated a significant difference between those with and without extraprostatic extension (HR=1.83 and p=0.0017), while local pathology failed to do so (HR=1.05 and p>0.8). The observations suggest that review of pathological stage and surgical margin of radical prostatectomy strongly improves their prognostic impact in multi-institutional studies or trials.
authors.affiliation: Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada, and Department of Urology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium. theo.vdkwast@uhn.on.ca
authors.forename: Theodorus H
authors.initials: TH
authors.lastname: van der Kwast
authors.forename: Laurence
authors.initials: L
authors.lastname: Collette
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
authors.forename: Paul
authors.initials: P
authors.lastname: Van Cangh
authors.forename: Kris
authors.initials: K
authors.lastname: Vekemans
authors.forename: Luigi
authors.initials: L
authors.lastname: DaPozzo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bosset
authors.forename: Karl H
authors.initials: KH
authors.lastname: Kurth
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Schröder
authors.forename: Michel
authors.initials: M
authors.lastname: Bolla
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D010340:Pathology, Surgical / Q000379:methods; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011785:Quality Assurance, Health Care