Background: To evaluate the pathologic features after radical prostatectomy to determine if the length of positive surgical margin (PSM) and the highest Gleason grade within the tumor at the PSM could risk stratify patients for biochemical recurrence (BCR).

Methods: We performed a retrospective, matched, cohort study to identify patients with pathologically organ-confined (pT2) tumors and negative nodes (pN0/Nx), receiving no adjuvant therapy. Specimens underwent single pathologist review. BCR-free survival was estimated using the Kaplan-Meier method and compared between subgroups using two-sided log-rank test. Using Classification and Regression Tree analysis (CART), we identified an optimal cutoff for the PSM length which differentiated risk for BCR. Cox proportional hazards regression models were fit to assess the association between variables and BCR-free survival.

Results: Two-hundred PSM patients were matched to 200 patients with negative surgical margins (NSM). Median follow-up was 64 months. 5 year BCR-free survival was 90% (95% CI 84-97%) in the NSM group and 70% (95% CI 63-79%) in the PSM group. There was an increased risk of BCR with any PSM. Multivariable analysis demonstrated an association with length of PSM ( > 1 mm vs. ≤ 1 mm, HR 2.29; 95% CI 1.2-4.5) and having a highest Gleason grade of the cancer focus at the margin ≥ 4 (HR 6.8; 95% CI 1.6-29).

Conclusions: We demonstrated that patients with pathologic T2 tumors with PSM > 1 mm or a Gleason grade of tumor focus at the margin ≥ 4 are at elevated risk for BCR. However, this study suggests that patients with pT2 tumors with positive surgical margins have a relatively low risk of biochemical recurrence and adjuvant radiation may be over treating this sub population. The subsets at greatest risk for BCR may benefit from more frequent PSA monitoring to direct salvage therapies.

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41391-017-0019-4DOI Listing

Publication Analysis

Top Keywords

gleason grade
16
risk bcr
16
highest gleason
12
grade tumor
12
biochemical recurrence
12
radical prostatectomy
8
positive surgical
8
pt2 tumors
8
bcr-free survival
8
surgical margins
8

Similar Publications

Objectives: This research aimed to compare the prostate cancer (PCa) features, survival rate, and functional outcomes after open suprapubic Radical Prostatectomy (RP) between younger men (≤ 55 years) and older men (> 55 years).

Methods: In this retrospective cohort study, we studied 134 patients with clinically localized PCa who underwent RP at our centers between 2011 and 2019, with 26 (19.40%) patients aged ≤ 55.

View Article and Find Full Text PDF

Low-grade myofibroblastic sarcoma is an uncommon malignancy that can be difficult to identify and for which there is no unified treatment protocol. We report herein a case of an 81-year-old male who presented with a giant irregular breast mass and was diagnosed with low-grade myofibroblastic sarcoma. In this study we summarise the clinicopathological features of 13 reported cases of myofibroblastic sarcoma arising in the breast, present the diagnostic process and treatment procedure of our case, and discuss the differential diagnosis from other similar diseases, to provide constructive information and promote deep understanding of myofibroblastic sarcoma in the future.

View Article and Find Full Text PDF

Currently, the World Health Organization (WHO) grade of meningiomas is determined based on the biopsy results. Therefore, accurate non-invasive preoperative grading could significantly improve treatment planning and patient outcomes. Considering recent advances in machine learning (ML) and deep learning (DL), this meta-analysis aimed to evaluate the performance of these models in predicting the WHO meningioma grade using imaging data.

View Article and Find Full Text PDF

Objective: In advanced ovarian cancer, the majority of patients receive anti-angiogenic treatment with bevacizumab. However, its use is often associated with severe side effects, and not all patients benefit from the therapy. Currently, there are no reliable biomarkers to predict response to treatment.

View Article and Find Full Text PDF

Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer, with increasing global incidence and have poor prognosis. Tumour-infiltrating lymphocytes (TILs) are recognized as a key prognostic indicator and play a vital role in OSCC grading. However, current methods for TILs quantification are based on subjective visual assessments, leading to inter-observer variability and inconsistent diagnostic reproducibility.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!