title: Short (≤ 1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy.
abstract: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: It has been suggested that a very short positive margin does not confer additional risk of BCR after radical prostatectomy. This study shows that even very short PSM is associated with increased risk of BCR.
  
  
  OBJECTIVE
  To re-evaluate, in a larger cohort with longer follow-up, our previously reported finding that a positive surgical margin (PSM) ≤ 1 mm may not confer an additional risk for biochemical recurrence (BCR) compared with a negative surgical margin (NSM).
  
  
  METHODS
  Margin status and length were evaluated in 2866 men treated with radical prostatectomy (RP) for clinically localized prostate cancer at our institution from 1994 to 2009. We compared the BCR-free survival probability of men with NSMs, a PSM ≤ 1 mm, and a PSM < 1 mm using the Kaplan-Meier method and a Cox regression model adjusted for preoperative prostate-specific antigen (PSA) level, age, pathological stage and pathological Gleason score (GS).
  
  
  RESULTS
  Compared with a NSM, a PSM ≤ 1 mm was associated with 17% lower 3-year BCR-free survival for men with pT3 and GS ≥ 7 tumours and a 6% lower 3-year BCR-free survival for men with pT2 and GS ≤ 6 tumours (log-rank P < 0.001 for all). In the multivariate model, a PSM ≤ 1 mm was associated with a probability of BCR twice as high as that for a NSM (hazard ratio [HR] 2.2), as were a higher PSA level (HR 1.04), higher pathological stage (HR 2.7) and higher pathological GS (HR 3.7 [all P < 0.001]).
  
  
  CONCLUSIONS
  In men with non-organ-confined or high grade prostate cancer, a PSM ≤ 1 mm has a significant adverse impact on BCR rates.
authors: Department of Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA. Sergeyshikanov@gmail.com
authors: Sergey
authors: S
authors: Shikanov
authors: Pablo
authors: P
authors: Marchetti
authors: Vikas
authors: V
authors: Desai
authors: Aria
authors: A
authors: Razmaria
authors: Tatjana
authors: T
authors: Antic
authors: Hikmat
authors: H
authors: Al-Ahmadie
authors: Gregory
authors: G
authors: Zagaja
authors: Scott
authors: S
authors: Eggener
authors: Charles
authors: C
authors: Brendler
authors: Arieh
authors: A
authors: Shalhav
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis