Evaluating Incidence, Location, and Predictors of Positive Surgical Margin Among Chinese Men Undergoing Robot-Assisted Radical Prostatectomy

Abstract

Purpose To evaluate the incidence and locations of positive surgical margin (PSM) among Chinese men undergoing RARP and identify the preoperative predictors for PSM. Methods We retrospectively identified 393 patients who underwent RARP according to inclusion criteria by single surgeon in our hospital. PSM was defined as the presence of cancer adjacent to inked surface of the specimen and categorized into four groups based on locations: apex, posterolateral, base, and multifocal. Logistic regression analysis was performed to identify the predictors of overall and location-specific PSM. Results The overall PSM rate was 133/393 (34%). The PSM rates for pT2, pT3, and pT4 stage were 63/278 (23%), 50/89 (56%), and 20/26 (77%), respectively. The estimated rates for apical, posterolateral, basal, and multifocal PSM were 8%, 4%, 7%, and 14%, respectively. In univariate analysis, overall PSM related to tPSA, f/tPSA, percentage of positive needles, and Gleason score. Multifocal PSM correlated with smoking history, drinking history, tPSA, f/tPSA, percentage of positive needles, and Gleason score. In multivariate analysis, percentage of positive needles reminded the only independent predictor for overall (OR = 10.5, 95% CI: 2.58–44.4) and basal PSM (OR = 24.0, 95% CI: 3.22–179.4). The f/tPSA (OR = 2.59, 95% CI: 2.18–5.71) and percentage of positive needles (OR = 31.0, 95% CI: 3.17–303) were independent risk factors for multifocal PSM. Conclusion The multifocal sites were the most common location of positive surgical margin, followed by apical and basal sites among Chinese patients undergoing RARP. The percentage of positive needles was an independent predictor for overall, basal, and multifocal PSM.

Multiparametric MRI-based nomograms in predicting positive surgical margins of prostate cancer after laparoscopic radical prostatectomy

“…First, the PSMs rate was 46.6%, which was higher than the results reported by Qu et al. ( 4 ) (PSMs rate = 34%). The reason for the difference may be that the patients in our study were diagnosed at a later stage; specifically, 56.3% of the patients had a biopsy-based Gleason score ≥4 compared to 38% of patients in their study.…”

“…For high-risk patients, who can choose to retain one side or not to retain the neurovascular bundle during surgery, or to combine ADT before surgery to reduce the rate of PSMs. Previous studies have shown that several clinical and pathologic factors have the potential of predicting PSMs ( 4 , 8 , 23 ). Zhang et al.…”

“…Laparoscopic radical prostatectomy (LRP) has been widely used in clinical practice and is currently the main way to treat localized prostate cancer (PCa) (1). Of note, 29.1%-34% of patients who undergo LRP have positive surgical margins (PSMs) (2)(3)(4), which is an independent risk factor for biochemical recurrence (BCR) in patients after prostatectomy (5,6). And the results of a cohort study showed that PSMs poses a substantial financial burden (7).…”