title: The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years.
abstract: OBJECTIVE
  To evaluate the role of positive surgical margin (PSM) size/focality and location in relation to risk of biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  Clinicopathological data were collected from 904 patients who underwent RARP at a single European institution from 2002 to 2006. PSM status after RARP was defined as cancer cells at the inked margin, and was stratified by size/focality and location. The outcome variable was BCR, defined as a postoperative PSA level of ≥0.2 ng/mL. We modelled clinicopathological covariates including PSM size/focality and location using Cox proportional hazards regression. In subgroup analyses, we assessed the effect of PSM size and location at different pathological stages and grades of disease.
  
  
  RESULTS
  Compared with negative SM, a PSM of >3 mm/multifocal was associated with an increased risk of BCR in the entire cohort (hazard ratio [HR] 2.84, 95% confidence interval 1.76-4.59), while unifocal PSMs of ≤3 mm were not significantly associated with BCR. In subgroup analyses, the negative impact of >3 mm/multifocal PSM appeared greatest in those with lower postoperative stage and grade of disease. The prognostic role of PSM location was unconfirmed, although data indicated that posterolateral PSMs may be of lower significance in RARP patients. The study is limited by lack of central pathology review, and lack of statistical adjustment for tumour volume, lymph node status, and surgeon volume.
  
  
  CONCLUSIONS
  We found that men with >3 mm/multifocal PSMs have a higher risk of BCR than those with unifocal PSMs of ≤3 mm or negative SMs, especially if they have lower risk disease. Posterolateral margins may be of little significance in a RARP population.
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Achilles
authors.initials: A
authors.lastname: Ploumidis
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Mats
authors.initials: M
authors.lastname: Olsson
authors.forename: Olof
authors.initials: O
authors.lastname: Akre
authors.forename: Leif
authors.initials: L
authors.lastname: Haendler
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
authors.forename: Andreas
authors.initials: A
authors.lastname: Nilsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: Martin
authors.initials: M
authors.lastname: Jonsson
authors.forename: Christofer
authors.initials: C
authors.lastname: Adding
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: biochemical recurrence; location; positive surgical margins; robot-assisted radical prostatectomy; size