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BACKGROUND: Robotic-assisted laparoscopic radical prostatectomy is a current standard treatment for localized prostate cancer, with treatment failure defined by biochemical recurrence (BCR). Open radical prostatectomy series have identified the presence of a positive surgical margin (PSM) as a predictor of long-term recurrence, a measure that is affected by the surgeon׳s skill. We evaluate the effect of PSM parameters on BCR rates from robotic-assisted laparoscopic radical prostatectomy, across 3 high-volume institutions. METHODS: De-identifiable clinicopathological and histopathological data were prospectively collected for 4,001 patients with at least 3 years of follow-up. Kaplan-Meier plots and 3 statistical models were used to evaluate the effect of margin parameters on BCR, via crude rates, traditional multivariable Cox regression, and a propensity-adjusted Cox regression model. RESULTS: Overall, 37% of men with a PSM developed BCR compared with 10% of men with negative margins (hazard ratio [HR] = 1.81, 95% CI: 1.47-2.22). Length ≥3 mm or a multifocal positive margin was associated with a higher risk of BCR compared with negative margin cases. On multivariable Cox regression analysis of the positive margin cohort, only apical margins significantly predicted BCR relative to basal margins (HR = 2.03, 95% CI: 1.01-4.09), whereas there was no significant difference in BCR rates for posterolateral margins relative to basal margins (HR = 1.62, 95% CI: 0.84-3.11). Propensity-adjusted modeling confirmed a greater effect of apical compared with posterolateral PSM. CONCLUSIONS: A PSM length ≥3 mm is predictive of BCR, as is to a lesser extent multiple positive margins. In contrast to open prostatectomy series, posterolateral margins carry a smaller risk of BCR compared with apical margins.

Original publication

DOI

10.1016/j.urolonc.2014.11.005

Type

Journal article

Journal

Urol Oncol

Publication Date

03/2015

Volume

33

Pages

109.e7 - 109.13

Keywords

Biochemical recurrence, Length, Location, Positive surgical margin, Robotic-assisted prostatectomy, Disease-Free Survival, Humans, Kaplan-Meier Estimate, Male, Multivariate Analysis, Neoplasm Recurrence, Local, Proportional Hazards Models, Prospective Studies, Prostate, Prostate-Specific Antigen, Prostatectomy, Prostatic Neoplasms, Risk Factors, Robotic Surgical Procedures, Surgery, Computer-Assisted