Linear extent of positive surgical margin impacts biochemical recurrence after robot-assisted radical prostatectomy in a high-volume center

Porcaro, Antonio Benito; Tafuri, Alessandro; Sebben, Marco; Amigoni, Nelia; Shakir, Aliasger; Corsi, Paolo; Processali, Tania; Pirozzi, Marco; Rizzetto, Riccardo; Bernasconi, Riccardo; Cerrato, Clara; Tiso, Leone; Migliorini, Filippo; Novella, Giovanni; Brunelli, Matteo; Marco, Vincenzo De; Siracusano, Salvatore; Artibani, Walter

doi:10.1007/s11701-019-01039-5

Cited by 15 publications

(13 citation statements)

References 39 publications

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“…However, it has also strengths for data being collected prospectively and for the population being large and homogenous; additionally, blood groups were all determined at the Department of Transfusion Medicine of our hospital. Furthermore, we have already shown that the risk of biochemical recurrence associated with focal PSM, which closely related to the high-volume surgeon, while nerve-sparing surgery did not have any significant impact [26,27,[33][34][35]. As such, our study has also clinical implications for ABO-bgs being an independent predictor of PSM risk.…”

Section: Discussionmentioning

confidence: 52%

ABO blood group system and risk of positive surgical margins in patients treated with robot-assisted radical prostatectomy: results in 1114 consecutive patients

et al. 2021

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To test the hypothesis of associations between the ABO blood group system (ABO-bg) and prostate cancer (PCa) features in the surgical specimen of patients treated with robot-assisted radical prostatectomy (RARP). Between January 2013 and October 2020, 1114 patients were treated with RARP. Associations of ABO-bg with specimen pathological features were evaluated by statistical methods. Overall, 305 patients were low risk (27.4%), 590 intermediate risk (50%) and 219 high risk (19.6%). Pelvic lymph node dissection was performed in 678 subjects (60.9%) of whom 79 (11.7%) had cancer invasion. In the surgical specimen, tumor extended beyond the capsule in 9.8% and invaded seminal vesicles in 11.8% of cases. Positive surgical margins (PSM) were detected in 271 cases (24.3%). The most frequently detected blood groups were A and O, which were equally distributed for both including 467 patients (41.9%), followed by groups B (127 cases; 11.4%) and AB (53 subjects; 4.8%). Among specimen factors, the ABO-bgs associated only with the risk of PSM, which was higher for blood group O (30.4%) compared with group A (19.5%) after adjusting for other standard clinical predictors (odds ratio, OR = 1.842; 95% CI 1.352–2.509; p < 0.0001). Along the ABO-bgs, the risk of PSM was increased by group O independently by other standard preoperative factors. The ABO-bgs may represent a further physical factor for clinical assessment of PCa patients, but confirmatory studies are required.

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Section: Discussionmentioning

confidence: 52%

ABO blood group system and risk of positive surgical margins in patients treated with robot-assisted radical prostatectomy: results in 1114 consecutive patients

et al. 2021

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“…Positive surgical margins (PSM) have been associated with an increased risk of biochemical failure. Recently, a single PSM of >3 mm or multifocal PSM was associated with an increased risk of metastasis [30], whereas a single focus of PSM was not associated with biochemical failure [31]. Interestingly, the frequency of MRD subtypes detected was not significantly different between patients with pT3a PSM negative and positive prostate cancer although there were a limited number of pT3a-positive PSMs in the study [29].…”

Section: Discussionmentioning

confidence: 85%

“…Patients with only micrometastasis detected long-term follow-up and hormonal therapy at biochemical failure, and finally, those patients negative for MRD may require less frequent follow-up. The decision curve analysis was used to determine the net benefit of a medical decision, which is the difference between the benefit and harms of treatment [31]. In this study, the MRD prognostic evaluation was superior to the CAPRA-S score.…”

Section: Discussionmentioning

confidence: 98%

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Murray

Aedo

Fuentealba

et al. 2020

ecancer

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Objective: The objective of this study was to compare the CAPRA-S score (based on clinicopathological findings) and the subtypes of minimal residual disease (MRD) (based on the biological properties of cancer cells) to predict biochemical failure (BF) after prostatectomy radical. Patients and methods: This was a prospective single-centre study of men who underwent radical prostatectomy. One month after surgery, the blood and bone marrow were taken for circulating prostate cell (CPC) and micrometastasis detection, identified using anti-PSA immunocytochemistry and defined as positive or negative. Patients were classified as Group A: CPC and micrometastasis negative, Group B: micrometastasis positive and CPC negative and Group C: CPC positive. CAPRA-S scores were classified as low, intermediate and high risk. Kaplan-Meier curves for biochemical failure-free survival (BFFS) and restricted mean survival time (RMST) to biochemical failure were determined and compared for up to 10 years. Results: 347 men participated with a median follow-up of 7 years, BFFS decreased proportionally with increasing CAPRA-S score and HR 1.13 and 1.65 for intermediate and high risk, respectively. After 10 years, the BFFS and RMST were 68%, 47% and 16% and 9, 7 and 6 years, respectively. The BFFS curves for MRD were not proportional; Group A and B BFFSs were similar up to 5 years, and then, there was an increasing failure in Group B patients After 10 years, the BFFS and RMST were 95%, 57% and 27% and 10, 9 and 6 years respectively. The CAPRA-S score failed to distinguish between Groups A and B, and one-third of high-risk Group C had low-risk CAPRA-S scores. MRD hazard ratios were Group B 1.76 and Group C 4.03. Research

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“…The incidence of positive MOR ranges from 6–38% in robotic and open prostatectomies [ 22 , 23 , 24 ]. A lower risk of positive margins has been shown for robotic assisted prostatectomy compared to the open surgical technique in a prospective study [ 25 ], especially in low stage disease and in experienced surgeons [ 26 ].…”

Section: Factors Affecting the Probability Of Margin Positivitymentioning

confidence: 99%

“…The patient’s characteristics may also influence the frequency of positive margins. Increased BMI is considered a surgical challenge, however, it is linked with a lower risk of positive MOR because the prostate in this setting is surrounded by plenty of fat, facilitating the surgical excision of the gland with a safe margin [ 23 , 24 , 35 ]. Additionally, total testosterone levels have been associated with positive MOR rates [ 35 , 36 ].…”

Section: Factors Affecting the Probability Of Margin Positivitymentioning

confidence: 99%

Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter?

Grypari

Zolota

Tzelepi

2021

Cancers

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Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, and may prompt additional therapeutic intervention in the patients. The absence of a distinct capsule around the prostate and intraoperative manipulations that aim to minimize postoperative adverse effects, complicate its wide removal. Proper handling of the specimen during the gross processing is essential for accurate determination of the status of margins or resection. Positive margins, defined as the presence of neoplastic glands in the highlighted-with-ink margin of resection, range from 6–38%. The surgical technique, surgeon’s expertise and tumor (i.e., grade and stage) and patients’ (i.e., BMI) characteristics affect the rate of margin positivity. Extensive or multifocal and nonanterior/nonapical positive margins are linked with higher recurrence rates, especially in organ-confined disease, underscoring the need for treating these patients more aggressively. In summary, detailed description of the status of the margins should be performed in every pathology report to determine patients’ prognosis and the most appropriate therapeutic plan.

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Linear extent of positive surgical margin impacts biochemical recurrence after robot-assisted radical prostatectomy in a high-volume center

Cited by 15 publications

References 39 publications

ABO blood group system and risk of positive surgical margins in patients treated with robot-assisted radical prostatectomy: results in 1114 consecutive patients

ABO blood group system and risk of positive surgical margins in patients treated with robot-assisted radical prostatectomy: results in 1114 consecutive patients

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter?

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