title: Identification of prostate cancer risk categories according to surgical margins status, pathological stage and Gleason score.
abstract: OBJECTIVE
  One-third of patients with positive surgical margins after radical prostatectomy develop recurrent disease. The distinction between pT2 with positive margins and pT3a can be difficult. Aim of the present study was to assess the impact of positive surgical margins on biochemical relapse after radical prostatectomy, adjusted for pathological stage and Gleason score.
  
  
  METHODS
  We retrospectively evaluated 837 consecutive patients who underwent radical prostatectomy for organ-confined or locally-advanced prostate cancer. Exclusion criteria were: presence of node or distant metastases, neo-adjuvant or adjuvant therapy, and unavailability of full data regarding pathological stage and margin status. A single dedicated genitourinary pathologist evaluated all the specimens. The Kaplan-Meier method and univariable and multivariable Cox regressions were applied for survival analyses.
  
  
  RESULTS
  The median follow up was 54.0 ± 35.0 months. Margin status, prostate-specific antigen and Gleason score significantly predicted biochemical relapse in the pT2 group at multivariable analysis, whereas only pathological stage and pathological Gleason score were significant predictors of recurrence in pT3a patients. There were no significant differences in biochemical disease-free survival among pT2 with positive margins patients and pT3a patients (with or without positive surgical margins). Pathological Gleason score was the only significant predictor of biochemical relapse in patients with negative and positive margins, regardless of the pathological stage.
  
  
  CONCLUSIONS
  pT2 patients with positive surgical margins and pT3a (with or without positive margins) seem to have similar biochemical disease-free survival. Positive margins and pathological stage might be insufficient clinical predictors. Gleason score remains the most reliable prognostic factor.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Fiorentino
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.forename: Fabio
authors.initials: F
authors.lastname: Manferrari
authors.forename: Valerio
authors.initials: V
authors.lastname: Vagnoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
mesh_terms: D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: Gleason score; biochemical relapse; positive surgical margins; prostate cancer; radical prostatectomy