Population‐based determinants of radical prostatectomy surgical margin positivity

Williams, Stephen B.; D’Amico, Anthony V.; Weinberg, Aaron; Gu, Xiangmei; Lipsitz, Stuart R.; Hu, Jim C.

doi:10.1111/j.1464-410x.2010.09662.x

Cited by 23 publications

(13 citation statements)

References 35 publications

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“…The overall PSM rate in this study was higher than that of Western countries 12. A large proportion of our patients had PNI, a high Gleason score, a large number of positive cores in biopsy specimens, and/or high serum PSA, and may have been expected to have more advanced disease.…”

Section: Discussioncontrasting

confidence: 54%

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Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

et al. 2017

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This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineural invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis (P < 0.05). Gleason score (odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431–3.653, P = 0.001), perineural invasion (OR = 4.961, 95% CI = 2.656–9.270, P < 0.001), and number of positive cores (OR = 4.403, 95% CI = 1.878–10.325, P = 0.001) were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion (49.5%) was much higher than that with localized disease (17.8%). In contrast, prostate volume showed a protective effect against positive surgical margin (OR = 0.572, 95% CI = 0.346–0.945, P = 0.029). Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.

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Section: Discussioncontrasting

confidence: 54%

“…Owing to refinements in surgical technique and a downward stage migration during the PSA era, there was a decreasing tendency in PSM rate in Western countries recently. Williams et al 12. studied 4247 men diagnosed with prostate cancer who all underwent RP and found that PSM rate decreased from 21.3% in 2004 to 16.6% in 2006.…”

Section: Discussionmentioning

confidence: 99%

Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

et al. 2017

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“…For example, in the study by Vesey et al [24], relying on data from the British Association of Urological Surgeons complex operations database between 2004 and 2009, the unadjusted rates of positive surgical margins and biochemical recurrence were significantly different above versus below a threshold of 15–20 cases per year. Nonetheless, these findings were not replicated in a population-based assessment examining the same end point [55]. Similarly, lymphadenectomy is important for staging and possibly improving oncologic control, although the latter remains controversial.…”

Section: Evidence Synthesismentioning

confidence: 99%

A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy

Trinh¹,

Bjartell²,

Freedland³

et al. 2013

European Urology

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Context Due to the complexity and challenging nature of radical prostatectomy (RP), it seems reasonable to suppose that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as within the hospital. Objective To review systematically the association between hospital and surgeon volume and perioperative, oncologic, and functional outcomes after RP. Evidence acquisition A systematic review of the literature was performed, searching PubMed, Embase, and Scopus databases for original and review articles between January 1, 1995, and December 31, 2011. Inclusion and exclusion criteria comprised RP, hospital and/or surgeon volume reported as a predictor variable, a measurable end point, and a description of multiple hospitals or surgeons. Evidence synthesis Overall 45 publications fulfilled the inclusion criteria, where most data originated from retrospective institutional or population-based cohorts. Studies generally focused on hospital or surgeon volume separately. Although most of these analyses corroborated the impact of increasing volume with better outcomes, some others failed to find any significant effect. Studies also differed with respect to the proposed volume cut-off for improved outcomes, as well as the statistical means of evaluating the volume–outcome relationship. Five studies simultaneously compared hospital and surgeon volume, where results appear to suggest that the importance of either hospital or surgeon volume largely depends on the end point of interest. Conclusions Undeniable evidence suggests that increasing volume improves outcomes. Although it would seem reasonable to refer RP patients to high-volume centers, such regionalization may not be entirely practical. As such, the implications of such a shift in practice have yet to be fully determined and warrant further exploration.

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“…25 To produce a meaningful predictive and quality control tool for urologists, our study had several advantages over the Williams study. First, our dataset contained the results of over 28 000 RPs which may have given it power to detect differences that were not statistically significant given their small sample size limited to the Medicare population.…”

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confidence: 99%

Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata

Izard

Salazar

Chatterjee

et al. 2013

CUAJ

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Background: Positive surgical margins (PSM) are an important determinant of biochemical recurrence after radical prostatectomy (RP). We use a population-based cancer registry to evaluate PSM by stage, Gleason and prostate-specific antigen (PSA). Methods: We identified men undergoing RP from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2007. Differences between those with and without PSM were compared with chi-squared tests. The proportion of cases with PSM were stratified by PSA and Gleason sum for both pT2 and pT3a tumours. Factors associated with PSM were analyzed using chi square and multivariate logistic regression analysis. A composite variable was used in a second multivariate analysis to display the odds ratio (OR) for a PSM for each discrete combination of PSA, Gleason score and pT stage Results: In total, 28 461 RP patients were identified and a PSM was present in 19.5%. PSM were 42% in pT3a and 16% in pT2 cases. Higher PSAs (<4.0, 4-9.9, >10) were associated with higher proportions of PSM (12%, 20% and 28%, p < 0.001). Similarly, higher Gleason scores (≤6, 3+4, 4+3, ≥8) were associated with higher PSM (12%, 22%, 27% and 33%, p < 0.001). For pT2 tumours, the proportion of PSM ranged from 8% (Gleason ≤6, PSA <4.0) to 28% (Gleason 8-10, PSA ≥10). For pT3a tumours, the PSM was higher in each Gleason/PSA strata compared to those with pT2 tumours, reaching 63% for those with pT3a, Gleason 8-10, PSA >10 disease. On multivariate analysis, stage was the largest predictor for PSM (OR 3.05, 95% confidence interval 2.81-3.30), although Gleason score and PSA remained statistically significant. Conclusion: In this population-based study of PSM after RP, the proportion of PSM vary significantly within different PSA and Gleason strata for organ-confined and extracapsular disease. These data can be used as a reference for urologist self-assessment.

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Population‐based determinants of radical prostatectomy surgical margin positivity

Cited by 23 publications

References 35 publications

Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy

Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata

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