Impact of positive surgical margin location and perineural invasion on biochemical recurrence in patients undergoing radical prostatectomy

Zhenpeng Lian,Zhaowei He,Xiaoming Wang,Hongtuan Zhang,Shenfei Ma,Ranlu Liu

doi:10.1186/s12957-020-01977-7

Abstract

ObjectiveTo estimate the prognostic value of positive surgical margins (PSM) location and perineural invasion (PNI) for biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP).MethodsAll men with prostate cancer (PCa) who received RP in the second hospital of Tianjin Medical University from 2014 to 2018 were retrospectively identified. All patients met the following criteria: no neoadjuvant or adjuvant treatment, absence of lymph node invasion, or distant metastasis confirmed by surgery or imaging. Comparisons were made between cases with only apex positive (AM), isolated nonapical positive (OM), multiple positive (MM), and negative surgical margins (NSM). Patients were also subdivided according to the Gleason score and pathological tumor stage for analysis.ResultsA total of 416 patients available for analysis, of which 132 (31.7%) were PSM, 43 were AM, 37 were OM, and 52 were MM at a median follow-up of 27 months. The PNI was in 30.5% of patients. BCR occurred in 22.6% of patients during follow-up. Both AM and MM were noticed to be independent predictors of BCR with a hazard ratio of 4.192 (95% CI 2.185–8.042; p < 0.001) and 2.758 (95% CI 1.559–4.880; p < 0.001), respectively, when compared to NSM. Though the correlation was significant in univariate analysis, PNI was not an independent risk factor for BCR (p = 0.369). Subgroup analyses suggested that MM was not particularly predictive for BCR in the Gleason score < 8. The hole Cox regression model for the C-index was 0.843ConclusionsPSM location was a significant independent predictor of BCR in PCa, especially in patients with AM or MM, while PNI is a non-independent risk factor. Compared with other locations, AM has a higher BCR risk.

Highlights

Positive surgical margin (PSM) after radical prostatectomy (RP) for prostate cancer (PCa) has been consistently considered an effective predictor of postoperative biochemical recurrence (BCR) [1,2,3,4]
We discovered that patients with PSM and Perineural invasion (PNI) were more likely to develop BCR
In the present large, single-center study of RP cases, we have shown that patients with apical margin (AM) and multiple positive surgical margins (MM) showing as an independent predictor of BCR when compared to patients with negative surgical margins (NSM) on multivariate analysis

Summary

Introduction

Positive surgical margin (PSM) after radical prostatectomy (RP) for prostate cancer (PCa) has been consistently considered an effective predictor of postoperative biochemical recurrence (BCR) [1,2,3,4]. The impact of PSM location on BCR was reported several and remains controversial [10,11,12]. The existence of PNI is related to the adverse outcome for several malignancies, while the clinical significance of PNI was still controversial. Previous studies have shown that PNI is a predictor of adverse pathological and clinical features, as well as a strong predictor of BCR in PCa [13]. As a predictor of BCR, the independent value of PNI has not yet been established

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Conclusion