title: Favorable risk factors in patients with positive surgical margin after robot-assisted radical prostatectomy.
abstract: BACKGROUND
  Positive surgical margin (PSM) has classically been associated with biochemical recurrence (BCR) following radical prostatectomy (RP) and immediate adjuvant radiotherapy has been advocated based on two large randomized prospective clinical studies. However, a significant percentage of patients with PSM never experience BCR. This study evaluated factors potentially affecting risk of BCR among the patients with PSM after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  From a prospectively maintained database, 699 patients with localized prostate cancer who underwent a RARP without any adjuvant therapy were identified. Median follow up was 46.0 months. To determine the pathologic and clinical factors that influenced BCR, univariate and multivariate analyses using the Cox proportional hazards model were performed. BCR-free survival curves were estimated with Kaplan-Meier method.
  
  
  RESULTS
  Surgical margins were positive in 115 patients (16.5%), of whom 23 (20%) had BCR. In the univariate analyses, serum PSA level, surgical Gleason score (GS), and non-organ confined disease were significantly associated with BCR in men with PSM. Multivariate Cox analysis showed that BCR was significantly associated with PSA (p = 0.011), and the surgical GS (p = 0.008). In patients with lower PSA cutoff (5.3 ng/mL), GS ≤ 7, and organ-confined disease, there were no BCR.
  
  
  CONCLUSIONS
  In this study, we identified favorable risk factors in patients with PSM following RARP. The results suggest that immediate adjuvant therapy for PSM may not be necessary in men with Gleason score 7 or less, organ-confined disease, and low preoperative PSA.
authors: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
authors: Yun-Sok
authors: YS
authors: Ha
authors: Dong Il
authors: DI
authors: Kang
authors: Jeong Hyun
authors: JH
authors: Kim
authors: Jae Young
authors: JY
authors: Joung
authors: Jihyeong
authors: J
authors: Yu
authors: Jaspreet S
authors: JS
authors: Parihar
authors: Amirali Hassanzadeh
authors: AH
authors: Salmasi
authors: Shigeo
authors: S
authors: Horie
authors: Wun-Jae
authors: WJ
authors: Kim
authors: Isaac
authors: I
authors: Yi Kim
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012372:ROC Curve; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome