Post-surgical margin status, risk group, and prognosis

A new study from researchers at the University of Toronto has shown that post-prostatectomy surgical margin status appears to have prognostic significance for patients in intermediate- and high-risk groups, but not for low-rsik patients.

Alkhateeb et al. accumulated data from 1,268 patients who received a radical prostatectomy for clinically localized prostate cancer at their institution between 1992 and 2008, but who received no other form of neoadjuvant or adjuvant treatment. They then assessed the relationship of age, pretreatment prostate specific antigen, pathological T stage, radical prostatectomy Gleason score, disease risk group, and surgical margin status to biochemical progression-free survival.

The results of this study showed the following:

  • The overall rate of positive surgical margins (PSMs) was 20.8 percent.
  • Median follow-up was 79 months.
  • Biochemical progression-free survival (bPFS) rates varied by risk group:
    • For patients with low-risk disease, those with PSMs had a bPFS of 94.9 percent vs. 99.6 percent for those with negative margins.
    • For the intermediate-risk patients, patients with PSMs had a bPFS of 83.0 percent vs. 93.5 percent for the negative margin group.
    • For those with high-risk disease, patients with PSMs had a bPFS of  571. percent vs. 78.5 percent  for the negative margin group.

According to the authors, these differences were statistically significant in a multivariate model when adjustments were made to address the other clinicopathological features. They conclude that, “Positive surgical margins are an independent predictor of biochemical progression in patients with intermediate and high risk prostate cancer. Patients with low risk disease have a favorable long-term outcome regardless of margin status and may be candidates for expectant management even with positive surgical margins, sparing them the side effects and costs of treatment.”

These data would appear to be “logically consistent” with experience, in that lower risk patients may, in any case, have generally less aggressive disease. It is evident from the data above that patients in the intermediate- and high-risk groups are at significant risk for progression regardless of their post-surgical margin status, and this is already known from other clinical series.

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