Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer

Brian F. Chapin, Jenny N. Nguyen, Mary F. Achim, Neema Navai, Stephen Williams, Ina N. Prokhorova, Xuemei Wang, Elsa M.Li Ning Tapia, John W. Davis, Patricia Troncoso

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)1-7
    Number of pages7
    JournalProstate Cancer and Prostatic Diseases
    DOIs
    StateAccepted/In press - Dec 11 2017

    Fingerprint

    Prostatectomy
    Prostatic Neoplasms
    Recurrence
    Neoplasms
    Survival
    Margins of Excision
    Salvage Therapy
    Proportional Hazards Models
    Cohort Studies
    Regression Analysis
    Radiation

    ASJC Scopus subject areas

    • Oncology
    • Urology
    • Cancer Research

    Cite this

    Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer. / Chapin, Brian F.; Nguyen, Jenny N.; Achim, Mary F.; Navai, Neema; Williams, Stephen; Prokhorova, Ina N.; Wang, Xuemei; Tapia, Elsa M.Li Ning; Davis, John W.; Troncoso, Patricia.

    In: Prostate Cancer and Prostatic Diseases, 11.12.2017, p. 1-7.

    Research output: Contribution to journalArticle

    Chapin, Brian F. ; Nguyen, Jenny N. ; Achim, Mary F. ; Navai, Neema ; Williams, Stephen ; Prokhorova, Ina N. ; Wang, Xuemei ; Tapia, Elsa M.Li Ning ; Davis, John W. ; Troncoso, Patricia. / Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer. In: Prostate Cancer and Prostatic Diseases. 2017 ; pp. 1-7.
    @article{56032cb00617449b81c12af07a8a107e,
    title = "Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer",
    abstract = "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.",
    author = "Chapin, {Brian F.} and Nguyen, {Jenny N.} and Achim, {Mary F.} and Neema Navai and Stephen Williams and Prokhorova, {Ina N.} and Xuemei Wang and Tapia, {Elsa M.Li Ning} and Davis, {John W.} and Patricia Troncoso",
    year = "2017",
    month = "12",
    day = "11",
    doi = "10.1038/s41391-017-0019-4",
    language = "English (US)",
    pages = "1--7",
    journal = "Prostate Cancer and Prostatic Diseases",
    issn = "1365-7852",
    publisher = "Nature Publishing Group",

    }

    TY - JOUR

    T1 - Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer

    AU - Chapin, Brian F.

    AU - Nguyen, Jenny N.

    AU - Achim, Mary F.

    AU - Navai, Neema

    AU - Williams, Stephen

    AU - Prokhorova, Ina N.

    AU - Wang, Xuemei

    AU - Tapia, Elsa M.Li Ning

    AU - Davis, John W.

    AU - Troncoso, Patricia

    PY - 2017/12/11

    Y1 - 2017/12/11

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=85037698281&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85037698281&partnerID=8YFLogxK

    U2 - 10.1038/s41391-017-0019-4

    DO - 10.1038/s41391-017-0019-4

    M3 - Article

    C2 - 29230008

    AN - SCOPUS:85037698281

    SP - 1

    EP - 7

    JO - Prostate Cancer and Prostatic Diseases

    JF - Prostate Cancer and Prostatic Diseases

    SN - 1365-7852

    ER -