Prognostic impact of subclassification of radical prostatectomy positive margins by linear extent and Gleason grade Journal Article


Authors: Udo, K.; Cronin, A. M.; Carlino, L. J.; Savage, C. J.; Maschino, A. C.; Al-Ahmadie, H. A.; Gopalan, A.; Tickoo, S. K.; Scardino, P. T.; Eastham, J. A.; Reuter, V. E.; Fine, S. W.
Article Title: Prognostic impact of subclassification of radical prostatectomy positive margins by linear extent and Gleason grade
Abstract: Purpose: We evaluated the relationship of progression to positive surgical margin linear length and Gleason grade at a positive surgical margin. Materials and Methods: We studied 2,150 prostatectomies done for pT2 or pT3a disease to determine grade, stage and surgical margin status. In patients with positive surgical margins we recorded the location, number, positive margin linear length and highest Gleason grade at a positive margin. The Kaplan-Meier method and log rank test were used to determine differences in progression-free probability among positive margin features. The concordance index was used to discriminate the accuracy of grouping surgical margin status as negative/positive vs positive margin linear length/highest Gleason grade. Results: A total of 207 cases (10%) showed positive surgical margins, including 93 (45%) that were pT2+ and 114 (55%) that were pT3a. Patients with pT3a and positive margins had greater prostate specific antigen and tumor volume, and Gleason score 7 or greater than those with pT2+. A total of 45 patients with positive margins progressed. We then subcategorized positive margins. Of the patients 164 (79%) had 1 positive margin. Positive margin linear length was 1 mm or less, 1.1 to 3 and greater than 3 in 104 (50%), 55 (27%) and 48 cases (23%), respectively. Two-year progression-free probability was 95%, 91%, 83% and 47% in patients with negative margins and the 3 positive margin linear length groups, respectively (p <0.001). Gleason grade at a positive margin was 3 and 4/5 in 154 (74%) and 53 patients (26%), respectively. The latter group was significantly more likely to progress (p <0.001). The overall margin status concordance index was 0.636. It was not considerably enhanced by categorizing by positive surgical margin linear length/highest Gleason grade at positive margins. Conclusions: The linear extent of and highest Gleason grade at a positive surgical margin are associated with progression. However, subcategorization does not importantly add to predictive models using margin status only. More robust markers are needed in patients with positive surgical margins to warrant routine reporting and identify those at risk for biochemical recurrence. © 2013 American Urological Association Education and Research, Inc.
Keywords: pathology; prostatic neoplasms; prostate; disease progression
Journal Title: Journal of Urology
Volume: 189
Issue: 4
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2013-04-01
Start Page: 1302
End Page: 1307
Language: English
PROVIDER: scopus
PUBMED: 23063630
DOI: 10.1016/j.juro.2012.10.004
DOI/URL:
Notes: --- - "Export Date: 1 May 2013" - "CODEN: JOURA" - ":doi 10.1016/j.juro.2012.10.004" - "Source: Scopus"
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MSK Authors
  1. Caroline Savage
    80 Savage
  2. Peter T Scardino
    624 Scardino
  3. Satish K Tickoo
    376 Tickoo
  4. Anuradha Gopalan
    293 Gopalan
  5. Angel M Cronin
    145 Cronin
  6. James Eastham
    437 Eastham
  7. Kazuma Udo
    10 Udo
  8. Samson W Fine
    336 Fine
  9. Victor Reuter
    978 Reuter