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Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naïve patients.
MedLine Citation:
PMID:  20883488     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: • To study the impact of positive surgical margins (PSMs) as an independent predictor of prostate-specific antigen (PSA) failure after radical prostatectomy in adjuvant treatment-naïve patients.
PATIENTS AND METHODS: • From 2000 to 2008, 1943 men who underwent a radical prostatectomy at Henri Mondor Hospital and who did not receive neoadjuvant or adjuvant therapy were included. Follow-up was recorded into a prospective database. Mean follow-up was 68.8 months. • The biochemical recurrence-free survival (RFS), defined by a PSA > 0.2 ng/mL, and the need for salvage therapy in univariate and multivariate models, were evaluated.
RESULTS: • PSA failure was reported in 14.7% and PSMs were noted in 25.6%. In the overall cohort, PSM was significantly predictive for PSA failure (P < 0.001; hazard ratio, HR, 2.6), need for salvage therapy (P < 0.001; HR, 2.9) and specific deaths (P= 0.006; HR, 3.7). The 5-year RFS was 84.4% in men with negative margins compared to 57.5% in the case of PSM. • After stratification by pathological stage and Gleason score, margin status was significantly predictive for PSA failure in pT2 (P < 0.001), pT3a (P= 0.001) and/or Gleason score ≤7 cancers (P < 0.001), whereas the impact of PSM did not reach significance in pT3b (P= 0.196), pT4 (P= 0.061) and/or Gleason score ≥8 cancers (P= 0.115).
CONCLUSIONS: • PSMs are associated with a poor prognosis in terms of RFS and the need for salvage therapy. • Such a distinction between negative or positive margin cancers appears to be clinically less relevant in locally advanced disease with seminal vesicle or high Gleason score (≥8).
Guillaume Ploussard; Mohammad Ali Agamy; Olivier Alenda; Yves Allory; Pascal Mouracade; Dimitri Vordos; Andras Hoznek; Claude-Clément Abbou; Alexandre de la Taille; Laurent Salomon
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Publication Detail:
Type:  Journal Article     Date:  2010-09-30
Journal Detail:
Title:  BJU international     Volume:  107     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1748-54     Citation Subset:  IM    
Copyright Information:
Department of Urology and Pathology, Hospital Henri Mondor, Créteil, France.
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