Abstract

ROSAS-NAVA, J.E. et al. Value of Positive Resection Margins in Patients with pT2 Prostate Cancer: Implications for Adjuvant Treatment. Actas Urol Esp [online]. 2011, vol.35, n.5, pp.272-276. ISSN 0210-4806.

Objective: To analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer (pT2) in the prostatectomy specimen and its implications for adjuvant treatment. Materials and method: Retrospective study of 536 patients with stage pT2 prostate cancer, treated with radical prostatectomy between 1996 and 2007. Subsequent to the prostatectomy, the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins and perineural invasion. We performed a univariate analysis and subsequently adjusted it by means of a Cox proportional hazard model (enter method). Results: 21.7% presented positive surgical margins and 20.9% developed biochemical recurrence after a mean follow-up of 57 months. 37.9% of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16% that did not have it (p<0.001). In the multivariate analysis, only the surgical margin (p<0.001) and the Gleason score greater or equal to 8 (p<0.001) behaved as independent biochemical recurrence factors. On stratifying the series according to these two variables, we found that the patients with positive surgical margins and a Gleason score of < 7 have a recurrence probability at 5 and 10years of 35% and 50% against 74% and 87% in the group with positive surgical margins and a Gleason score of > 8 (p=0.002). Conclusion: Patients with pT2 prostate cancer, positive surgical margins and a Gleason score of > 8 will benefit from adjuvant radiotherapy. 50% of the patients with positive margins and a Gleason score of < 7 will not recur, which means that the indication of adjuvant radiotherapy continues to be controversial.

Keywords : Prostate cancer; Radical prostatectomy; pT2 stage; Prognostic factors; Recurrence; Positive surgical margins; Adjuvant radiotherapy.

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