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Positive Margin Following Radical Prostatectomy Fails to Predict Progression to Biochemical Failure
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Positive Margin Following Radical Prostatectomy Fails to Predict Progression to Biochemical Failure
Sarah D. Psutka, MD, David Rodin, MD, Adam S. Feldman, MD, Chin-Lee Wu, MD, W. Scott S. McDougal, MD.
Massachusetts General Hospital, Cambridge, MA, USA.
Background: To define the role of margin positivity following radical retropubic prostatectomy (RRP) as a predictor of biochemical failure (BCF) and the role for adjuvant radiation therapy.
Methods: With IRB approval, we surveyed 359 patients who underwent RRP between 1994 and 1995 and reviewed their records. We compared clinical and pathological characteristics and progression to BCF for the 236 patients with complete data and a minimum of 10 years follow-up (Mean 12 yrs, SD 1.5). A Time-to-Event analysis (Kaplan-Meier) and Univariate and Multivariate Cox regression models were used to determine the role of surgical margin positivity in progression to BCF when controlling for Gleason score, tumor stage (P2, P3), volume (1-4 quadrants), Seminal Vesicle (SV) involvement, and perineural invasion. This regression analysis was used to assess the effect of adjuvant radiotherapy on time-to-BCF in patients with positive and negative margins when compared to a match group of patients who did not receive radiotherapy.
Results: Of 236 patients, 28% had positive margins on surgical pathology. Among all patients, positive margins were predictive of more rapid progression to BCF (p=0.0001). When stratified by disease volume, positive margins are found to be predictive of shorter time to progression to BCF in patients with disease in 3-4 quadrants (p=0.002) but not when disease was confined to 1-2 quadrants (p=0.11). When this population is further stratified by disease stage, patients with P2 disease and positive margins with high volume disease progress to BCF more rapidly that those with negative margins (p=0.003). However, among patients with high volume P3 disease, there is no significant difference in progression to BCF due to surgical margin positivity (p=0.51). In the P3 group, Multivariate analysis by Cox Regression demonstrated that adjuvant XRT does not improve time to BCF, RR=1.13 [95%CI 0.38, 3.14; p=0.81].
Conclusions: After controlling for tumor volume, pathologic stage, perineural invasion, SV invasion, and Gleason score, we found that positive surgical margin is not significantly associated with accelerated progression to BCF except in those patients with organ-confined high volume disease. In patients with P3 disease and positive margins, adjuvant XRT does not appear to improve time to progression to BCF at ten years.
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