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Title: The number of positive section margins in high-risk prostate cancer is a powerful and independent predictor of cancer-specific and overall survival in high-risk localized prostate cancer
Authors: Joniau, Steven
Gontero, P
Briganti, A
Marchioro, G
Capitanio, U
Tombal, B
Hsu, C. Y
Akdogan, B
Bader, P
Frea, B
Frohneberg, D
Kneitz, B
Riedmiller, H
Tizzani, A
Van Poppel, Hendrik
Spahn, M #
Issue Date: Mar-2011
Publisher: Elsevier science bv
Host Document: European urology supplements vol:10 issue:2 pages:285-285
Conference: Annual EAU Congress edition:26 location:Vienna, Austria date:18-22 March 2011
Article number: 907
Abstract: Introduction & Objectives: The predictive value of positive section margins(PSM) at radical prostatectomy (RP) for disease recurrence is well established. However, controversy remains regarding the predictive value of PSM for cancerrelated death or overall survival. We aimed to analyse the effect of the number of PSM in a multicenter European database of RP in high-risk localized PCa.

Materials & Methods: We retrospectively analyzed our institutional radical prostatectomy databases and included all consecutive patients with PSA >20 OR ≥cT3a OR biopsy Gleason score ≥8. All patients underwent a wide radical
prostatectomy with pelvic LND. All histopathological data were reviewed and patients were grouped into 0, 1, 2 or >2 PSM. Clinical data and data on cancerrelated death and overall survival were extracted from the case notes. Data were analysed with Kaplan-Meier analysis and log Rank test for cancer-specific (CSS)and overall survival (OS) using number of PSM as predictor. Cox multivariate regression analysis was used to study the impact of PSM, corrected for age at surgery, pathological stage, specimen Gleason score, PSA and lymph node status.

Results: Between April 1987 and April 2009, 1584 patients with cT3-4 OR PSA ≥20 ng/ml OR biopsy Gleason score ≥8 underwent a RP at seven European institutions. In 948 patients, number of PSM was available. Those were included
for further analysis. Mean age was 65.3 years (SD +/- 6.5). Mean PSA was 33.1 ng/ml (SD +/- 43.6). Of the patients, 288 (30.4%) presented with <cT3 and 660 (69.6%) with ≥T3 disease. Biopsy Gleason score was <8 in 742 (78.3%) and ≥8
in 206 (21.7%). Adjuvant treatment was administered in 59.8%. Mean follow up was 71.9 months (SD +/- 44.0). Number of PSM (0 vs. 1 vs. 2 vs. >2) was a strong predictor of CSS and OS on Kaplan-Meier analysis (both <0,0001). In cox
multivariate regression analysis, number of PSM (coded as a continuous variable) was an independent predictor of CSS (p=0.018, HR 1.15, 95% CI 1.03-1.29) and of OS (p=0.002, HR 1.15, 95% CI 1.05-1.25) (in CSS corrected for PSA, pathological stage, lymph node invasion and specimen GS; in OS also corrected for age).
Conclusions: The number of positive surgical margins is a strong and independent predictor of CSS and OS in patients with high-risk localized PCa.
URI: 
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
# (joint) last author

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