- 研究纳入 1,449 例有随访的多灶前列腺癌根治术病例，所有主灶切缘均为阴性。
- 校正 GG、肿瘤体积、前列腺外侵犯和精囊侵犯后，次要灶切缘阳性仍预测 BCR（HR 3.14；P=0.0002）。
- 作者指出，次要灶切缘阳性对 BCR 的影响似乎小于主灶特征的影响。
收录范围：仅 PubMed 英文摘要及中文翻译（abstract-only）；未取得开放获取（OA）全文。
摘要
切缘阳性（M+）、较高分级组（GG）、前列腺外侵犯（EPE）、精囊侵犯（SV+）及肿瘤体积（TV），均属于根治性前列腺切除术（RP）标本中与后续生化复发（BCR）具有较强独立相关性的因素。然而，当主灶以阴性切缘切除时，次要肿瘤灶 M+ 对 BCR 的预后意义尚未得到研究。研究回顾了 1,687 例多灶前列腺癌 RP 标本，对每个独立肿瘤灶的 GG、切缘状态、EPE、SV+ 及 TV 进行评估。排除无随访患者后，最终分析队列包括 1,449 例 RP。以最高 GG 确定主灶；GG 相同时，将分期较高的肿瘤定为主灶；GG 和分期均相同时，将 TV 较大的肿瘤定为主灶。所有病例的主灶均以阴性切缘切除。采用多变量逻辑回归分析评估次要灶切缘状态与 BCR 之间的关联。主灶分别为 GG1（n=195［13.5%］）、GG2（n=551［38.0%］）、GG3（n=308［21.2%］）、GG4（n=72［5.0%］）及 GG5（n=323［22.3%］）。主灶 TV 中位数为 0.73 mL（范围：0.03–22）。481 例（33.2%）存在 EPE，77 例（5.3%）存在 SV+。74 例（5.1%）RP 标本的次要灶出现 M+，其中 GG1 为 32 例（43.2%）、GG2 为 33 例（44.6%）、GG3 为 4 例（5.4%）、GG4 为 3 例（4.1%）、GG5 为 2 例（2.7%）。137 例（9.4%）患者出现 BCR，62 例（4.3%）存在持续性 PSA。发生 BCR 者的中位随访时间为 855 天（范围：395–1,575），未发生者为 729 天（范围：236–1,582），P=0.045。在 Cox 比例风险模型中，校正 GG、TV、EPE 及 SV+ 后，次要灶 M+ 可预测 BCR（HR：3.14；P=0.0002）。除 GG2 和 EPE 外，其他所有 RP 病理指标均与 BCR 存在统计学显著相关性：GG3（HR：9.53；P=0.0002）、GG4（HR：16.4；P<0.0001）、GG5（HR：14.2；P<0.0001）、TV（HR：1.16；P<0.0001）及 SV+（HR：3.03；P=0.0001）。既往发表的文献表明，主灶 M+ 是 BCR 最强的预测因素之一；相比之下，次要灶 M+ 对 BCR 的影响似乎小于主灶特征的影响。
- The analytical cohort included 1,449 radical prostatectomies with multifocal prostate cancer and follow-up; all dominant tumors had clear margins.
- After adjustment for GG, tumor volume, extraprostatic extension and seminal vesicle invasion, secondary tumor margin positivity predicted BCR (HR 3.14; P=0.0002).
- The authors suggest that secondary tumor margin positivity has a lesser effect on BCR than dominant tumor characteristics.
Scope: PubMed abstract only; no open-access full text was obtained.
Abstract
Positive surgical margin (M+), higher-grade group (GG), extraprostatic extension (EPE), seminal vesicle invasion (SV+), and tumor volume (TV) are among the factors at radical prostatectomy (RP) demonstrating strong independent correlations with subsequent biochemical recurrence (BCR). However, the prognostic significance of M+ in secondary tumors on BCR when a dominant tumor is excised with a clear margin has not been studied. A review of 1,687 RPs with multifocal prostate cancer was performed to assess GG, margin status, EPE, SV+, and TV for each individual tumor. The final analytical cohort consisted of 1,449 RPs, as patients without follow-up were excluded. The highest GG determined the dominant tumor. In tumors with equal GG, higher stage tumors were considered dominant. In tumors with equal GG and stage, a tumor with a larger TV was considered dominant. In all cases, the dominant tumor was excised with clear margins. Associations between secondary tumor margin status and BCR were evaluated using multivariable logistic regression analysis. The dominant tumors were GG1 (n=195 [13.5%]), GG2 (n=551 [38.0%]), GG3 (n=308 [21.2%]), GG4 (n=72 [5.0%]), and GG5 (n=323 [22.3%]). The median TV of the dominant tumor was 0.73 mL (range: 0.03 to 22). EPE was seen in 481 (33.2%) cases and SV+ in 77 (5.3%). In 74 (5.1%) RPs, a secondary tumor showed M+, composed of GG1 32 (43.2%), GG2 33 (44.6%), GG3 4 (5.4%), GG4 3 (4.1%), and GG5 2 (2.7%). BCR was observed in 137 (9.4%) patients, and 62 (4.3%) had persistent PSA. The median follow-up for patients with BCR was 855 days (range: 395 to 1,575) and for those without, 729 (range: 236 to 1,582), P=0.045. In the Cox proportional hazards model, after adjusting for GG, TV, EPE, and SV+, M+ in secondary tumors predicted BCR (HR: 3.14; P=0.0002). Except for GG2 and EPE, all other RP findings correlated statistically significantly with BCR: GG3 (HR: 9.53; P=0.0002), GG4 (HR: 16.4; P<0.0001), GG5 (HR: 14.2; P<0.0001), TV (HR: 1.16; P<0.0001), and SV+ (HR: 3.03; P=0.0001). While published literature indicates that M+ in the dominant tumor is one of the strongest predictors of BCR, M+ in secondary tumors appears to have a lesser effect on BCR than dominant tumor characteristics.