Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer

Kumano, Masafumi; Muramaki, Mototsugu; Kurahashi, Toshifumi; Takenaka, Atsushi; Fujisawa, Masato

doi:10.1007/s11255-008-9467-z

Cited by 14 publications

(29 citation statements)

References 18 publications

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“…Only 30 PSMs were present in our study and therefore reduced the statistical power of our analysis. However, our PSM rate was comparable with other studies of a similar nature, for example Kumano et al (2009) [29], suggesting that the population was representative. Another limitation of the current study was that data were missing for many of the patients in our database.…”

Section: Discussionsupporting

confidence: 91%

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Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy

et al. 2016

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ObjectiveTo assess potential biases, such as the reporting pathologist, that may affect objectivity of T2 positive margin rates as a quality outcome measure following radical prostatectomy.Patients and methodsProspective data on 183 consecutive LRP patients with pT2 disease, operated on by a single surgeon (2003–2009), were studied. Outcomes were grouped as pre-, peri-, and post-operative and included: age, ethnicity, Gleason score, reporting pathologist, percentage of positive cores, operative time, blood loss, nerve-sparing status, hospital stay and prostate weight. Descriptive analysis and logistic regression analysis were carried out to compare these variables by positive margin status.ResultsA total of 30 (16.4 %) positive surgical margins (PSMs) were reported. Surgical stage, earlier date of surgery, and lower prostatic weight showed statistically significant associations with PSM status in both univariate and multivariate analysis. The reporting pathologist was not found to be predictive of PSMs (P = 0.855).ConclusionWe showed that the reporting pathologist does not influence T2 positive margin status, in contrast to tumour characteristics and surgeon experience. T2 positive margin assessment therefore appears to be an objective quality outcome measure.

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Section: Discussionsupporting

confidence: 91%

“…For example, several studies have found incidence of IPI to be 1.8–2.8 % [9, 11, 28]. However, some studies have reported rates of IPI as high as 20 % [29]. Indeed, in our study, 30 patients (16.4 %) presented with PSMs in T2 disease (IPI).…”

Section: Discussionmentioning

confidence: 48%

Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy

et al. 2016

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“…In our previous reports, isolated IPI rates in OC disease ranged from 1.8% to 2.3% [8,16]. However, others reported the IPI rates in OC disease as high as 20% [9,15]. This variation in IPI rate can be partly attributed to pathologic interpretation.…”

Section: Discussionmentioning

confidence: 90%

“…Most studies that evaluated the prognostic significance of IPI reported the IPI rate in men with organ-confined (OC) disease only [6–9,15]. The current study was performed to evaluate the IPI rate across different pathologic stages and to identify predictors of IPI.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy

Park

Readal²,

Jeong

et al. 2015

European Urology

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Background Histologically identified intraprostatic incision (IPI) into malignant glands is associated with an increase in biochemical recurrence following radical prostatectomy (RP). However, the predictor of IPI is poorly evaluated. Objective To evaluate the risk factors for IPI into cancer during RP for clinically localized prostate cancer (PCa). Design, setting, and participants Between January 1993 and July 2013, 19 986 men with clinically localized PCa underwent RP at our institution. This study includes 14 434 cases that had complete clinicopathologic data. IPI was defined as an iatrogenic incision into the prostate resulting in the presence of malignant glands at the inked surgical margin, regardless of accompanying pathologic features. Intervention Open, retropubic, robot-assisted laparoscopic and pure laparoscopic RP. Outcome measurements and statistical analysis Univariate and multivariable logistic regression analyses were conducted for risk factors of IPI in RP specimens. Results and limitations The overall incidence of IPI into malignant tissue was noted in 410 (2.8%) cases. In multivariable analysis, obesity, lower prostate weight, surgeon experience, and pure laparoscopic RP were associated with a higher risk of IPI. The odds ratios (OR) for body mass index and prostate weight were 1.05 (95% confidence interval [CI], 1.03–1.08; p < 0.001) and 0.99 (95% CI, 0.98–0.99, p < 0.001), respectively. The ORs for surgeon experience (>250 cases) and pure laparoscopic RP compared to open RP were 0.71 (95% CI, 0.55–0.90, p = 0.005) and 2.05 (95% CI, 1.35–3.11; p = 0.001), respectively. Conclusions The risk of IPI during RP is higher in men with obesity and lower prostate weight. In addition, a pure laparoscopic RP and the early series of each surgeon were associated with a higher risk of IPI. However, tumor characteristics were not associated with the IPI occurrence. Patient summary Intraprostatic incision occurrence is associated with obesity, small prostate, and surgeon experience and laparoscopic technique but not Gleason score and tumor stage.

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“…This is likely explained by the fact that we used a strict definition of PNI, that of circumferential encirclement of nerves by malignant glands. In contrast, prior studies reporting a higher PNI prevalence either did not describe how PNI was defined (14, 19, 20, 25, 39) or used vague descriptions such as presence of tumor cells “in the perineural space” (16, 18) or “along the perineural sheath” (21). Because the perineural space can often be difficult to identify using H&E stains alone, abutment of the perineural space by both malignant and benign glands can, in the absence of circumferential involvement, be misinterpreted as PNI (53, 54), resulting in misclassification.…”

Section: Discussionmentioning

confidence: 98%

Perineural Invasion and Risk of Lethal Prostate Cancer

Zareba

Flavin

Isikbay

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Prostate cancer has a propensity to invade and grow along nerves, a phenomenon called perineural invasion (PNI). Recent studies suggest that presence of PNI in prostate cancer has been associated with cancer aggressiveness. Methods We investigated the association between PNI and lethal prostate cancer in untreated and treated prostate cancer cohorts: the Swedish Watchful Waiting Cohort of 615 men who underwent watchful waiting, and the U.S. Health Professionals Follow-Up Study of 849 men treated with radical prostatectomy. One pathologist performed a standardized histopathologic review assessing PNI and Gleason grade. Patients were followed from diagnosis until metastasis or death. Results The prevalence of PNI was 7% and 44% in the untreated and treated cohorts, respectively. PNI was more common in high Gleason grade tumors in both cohorts. PNI was associated with enhanced tumor angiogenesis, but not tumor proliferation or apoptosis. In the Swedish study, PNI was associated with lethal prostate cancer (odds ratio, OR, 7.4, 95% confidence interval, CI, 3.6, 16.6; p<0.001). A positive, though not statistically significant, association persisted after adjustment for age, Gleason grade, and tumor volume (OR 1.9, 95% CI 0.8, 5.1; p=0.17). In the U.S. study, PNI predicted lethal prostate cancer independent of clinical factors (HR 1.8, 95% CI 1.0, 3.3; p=0.04). Conclusion These data support the hypothesis that perineural invasion creates a microenvironment that promotes cancer aggressiveness. Impact Our findings suggest that PNI should be a standardized component of histopathologic review, and highlights a mechanism underlying prostate cancer metastasis.

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Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer

Abstract: Despite the lack of independent significance, the presence of CI has an adverse impact on biochemical outcome in patients undergoing RP for clinically localized prostate cancer.

Cited by 14 publications

References 18 publications

Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy

Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy

Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy

Perineural Invasion and Risk of Lethal Prostate Cancer

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