title: A close surgical margin after radical prostatectomy is an independent predictor of recurrence.
abstract: OBJECTIVE
  The term close surgical margin refers to a tumor extending to the inked margin of the specimen without reaching it. Current guidelines state that a close surgical margin should simply be reported as negative. However, this recommendation remains controversial and relies on limited evidence. We evaluated the impact of close surgical margins on the long-term risk of biochemical recurrence after radical prostatectomy.
  
  
  METHODS
  We identified 1,195 consecutive patients who underwent radical prostatectomy and lymphadenectomy for localized prostate cancer at our institution from 1993 to 1999. In 894 of these patients associations between margin status and location, Gleason score, pathological stage, preoperative prostate specific antigen, prostate weight and age with the risk of biochemical recurrence were examined.
  
  
  RESULTS
  Of these 894 patients 644 (72%) had negative margins and of these patients 100 (15.5%) had close surgical margins. In the group with prostate specific antigen failure, median time to recurrence was 3.5 years. In the group without recurrence median followup was 9.9 years. Cumulative recurrence-free survival differed significantly among positive, negative and close surgical margins (p <0.001). On multivariate analysis a close surgical margin constituted a significant, independent predictor of recurrence (HR 2.1, 95% CI 1.04-4.33). Gleason score and positive margins were the strongest prognostic factors.
  
  
  CONCLUSIONS
  In this cohort close surgical margins were independently associated with a twofold risk of postoperative biochemical recurrence. Further evaluation of the clinical significance of close surgical margins is indicated as they might be an indicator of local recurrence and of relevance when considering salvage therapy.
authors.affiliation: Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Jian
authors.initials: J
authors.lastname: Lu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wirth
authors.forename: Shulin
authors.initials: S
authors.lastname: Wu
authors.forename: Junxing
authors.initials: J
authors.lastname: Chen
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Dahl
authors.forename: Aria F
authors.initials: AF
authors.lastname: Olumi
authors.forename: Robert H
authors.initials: RH
authors.lastname: Young
authors.forename: W Scott
authors.initials: WS
authors.lastname: McDougal
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen