PD43-07 IMPACT OF POSITIVE SURGICAL MARGIN LENGTH AND GLEASON GRADE AT THE MARGIN ON ONCOLOGIC OUTCOMES IN PATIENTS WITH NON-ORGAN-CONFINED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-07 IMPACT OF POSITIVE SURGICAL MARGIN LENGTH AND GLEASON GRADE AT THE MARGIN ON ONCOLOGIC OUTCOMES IN PATIENTS WITH NON-ORGAN-CONFINED PROSTATE CANCER Felix Preisser*, Alexander Heinze, Raisa Pompe, Felix Chun, Markus Graefen, Hartwig Huland, and Derya Tilki Felix Preisser*Felix Preisser* More articles by this author , Alexander HeinzeAlexander Heinze More articles by this author , Raisa PompeRaisa Pompe More articles by this author , Felix ChunFelix Chun More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Hartwig HulandHartwig Huland More articles by this author , and Derya TilkiDerya Tilki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the Gleason grade at the PSM, on the oncologic outcomes in non-organ-confined RP patients. METHODS: Within a high-volume center database we identified patients who harbored non-organ-confined (pT3) prostate cancer (PCa) at RP between 2010 and 2016. Only patients without lymph node invasion were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of PSM on biochemical recurrence (BCR), metastasis and death after RP in patients without adjuvant radiotherapy. RESULTS: Overall, 3,706 patients were identified. Of those, 27.2% (n=1,008) harbored PSM. Patients with PSM had higher median PSA values (11.0 vs. 7.9ng/ml, p<0.001), higher proportion of primary Gleason ≥4 (56.0 vs. 38.7%, p<0.001) and more frequently harbored seminal vesicle invasion (45.9 vs. 22.0%, p<0.001). At 72 months after RP, BCR-free, metastasis-free and overall survival was 44.4 vs. 64.7%, 63.3 vs. 79.4% and 91.2 vs. 93.4% for patients with vs. without PSM (all p<0.001). BCR-free, metastasis-free and overall survival rates at 72 months were 49.3 vs. 32.7% (p=0.1), 60.9 vs. 76.5% (p=0.7) and 91.3 vs. 98.4% (p=0.3) for unifocal vs. multifocal PSM; 62.7 vs. 25.8% (p<0.001), 88.5 vs. 36.1% (p<0.001) and 98.4 vs. 83.7% (p<0.01) for Gleason pattern 3 vs. ≥4 at the margin and 48.4 vs. 37.3% (p=0.03), 63.6 vs. 63.1% (p=0.3) and 91.7 vs 93.9% (p=0.9) for <4mm vs. ≥4mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (Hazard ratio [HR]: 1.25, p<0.01) and overall survival (HR:1.94, p=0.02). In subgroups of patients with PSM only, length of PSM (HR: 1.03, p=0.03) and Gleason ≥4 at the margin (HR:1.76, p<0.01) represented independent predictors for BCR. CONCLUSIONS: PSM represents an independent predictor for worse oncologic outcome in non-organ-confined PCa at RP. Gleason ≥4 at the margin was an independent predictor for BCR and associated with development of metastasis and death after RP. Moreover, length of PSM was an independent predictor for BCR. Next to margin status, Gleason at the margin and its length carry important information that should be reported for the specimen. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e903-e903 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Preisser* More articles by this author Alexander Heinze More articles by this author Raisa Pompe More articles by this author Felix Chun More articles by this author Markus Graefen More articles by this author Hartwig Huland More articles by this author Derya Tilki More articles by this author Expand All Advertisement PDF downloadLoading ...