Prognostic impact of positive surgical margins in surgically treated prostate cancer: Multi-institutional assessment of 5831 patients

• Published in: Urology (Ridgewood, N.J.) N.J.), 2005-12, Vol.66 (6), p.1245-1250
• Main Authors: Karakiewicz, Pierre I., Eastham, James A., Graefen, Markus, Cagiannos, Ilias, Stricker, Phillip D., Klein, Eric, Cangiano, Thomas, Schröder, Fritz H., Scardino, Peter T., Kattan, Michael W.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Disease-Free Survival; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Nephrology. Urinary tract diseases; Prognosis; Prospective Studies; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Time Factors; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2005.06.108

To assess the prognostic significance of a positive surgical margin in the radical prostatectomy specimen, and to test for the presence of statistically significant interactions between surgical margin status and select pathologic stage variables. We combined prospectively collected data from 7816 consecutive patients treated with radical prostatectomy at eight institutions. The pretreatment serum prostate-specific antigen level, pathologic Gleason sum, surgical margin status (positive versus negative), presence of extracapsular extension, seminal vesicle involvement, and pelvic lymph node status were examined as predictors of the rate of biochemical progression in 5831 patients with complete records. In multivariate Cox regression models, a positive surgical margin was associated with a 3.7-fold greater risk of progression (P = 0.001). Moreover, a statistically significant interaction was found between surgical margin status and Gleason sum 7 to 10 (P = 0.008) and lymph node invasion (P