Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Do margins matter? the influence of positive surgical margins on prostate cancer-specific mortality
European Urology, Volume 65, No. 4, Year 2014
Notification
URL copied to clipboard!
Description
Background Positive surgical margins (PSMs) in radical prostatectomy (RP) specimens are a frequent indication for adjuvant radiotherapy and are used as a measure of surgical quality. However, the association between PSMs and prostate cancer-specific mortality (CSM) is poorly defined. Objective Analyze the association of PSMs with CSM, adjusting for fixed and time-dependent parameters. Design, setting, and participants Fine and Gray competing risk regression analysis was used to model the clinical data and follow-up information of 11 521 patients treated by RP between 1987 and 2005. Two extended models were used that adjusted for the use of postoperative radiotherapy, which was handled as a time-dependent covariate. Postoperative radiotherapy was modeled as a single parameter and also as early and late therapy, based on the prostate-specific antigen level at the start of treatment (≤0.5 vs >0.5 ng/ml). Intervention RP for clinically localized prostate cancer and selective use of secondary local and/or systemic therapy. Outcome measurements and statistical analysis The outcome measure was prostate cancer-specific mortality. Results and limitations The 15-yr CSM rates for patients with PSMs and negative surgical margins were 10% and 6%, respectively (p < 0.001). No significant association between PSM and CSM was observed in the conventional model with fixed covariates (hazard ratio [HR]: 1.04; 95% confidence interval [CI], 0.7-1.5; p = 0.8) or in the two extended models that adjusted for postoperative radiotherapy (HR: 0.96; 95% CI, 0.7-1.4; p = 0.9), or early and late postoperative radiotherapy (HR: 1.01; 95% CI, 0.7-1.4; p = 0.9). Conclusions PSMs alone are not associated with a significantly increased risk of CSM within 15 yr of RP. However, urologists should continue to strive to avoid PSMs, as they increase a man's risk of biochemical recurrence and need for secondary therapy and may be a source of considerable patient anxiety. © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Authors & Co-Authors
Stephenson, Andrew J.
United States, Cleveland
Cleveland Clinic Foundation
Eggener, Scott E.
United States, Chicago
The University of Chicago Medicine
Hernandez, Adrian V.
United States, Cleveland
Cleveland Clinic Foundation
Klein, Eric A.
United States, Cleveland
Cleveland Clinic Foundation
Kattan, Michael W.
United States, Cleveland
Cleveland Clinic Foundation
Wood, David P.
United States, Ann Arbor
University of Michigan, Ann Arbor
Rabah, Danny M.
Saudi Arabia, Riyadh
King Saud University
Eastham, James A.
United States, New York
Memorial Sloan-kettering Cancer Center
Scardino, Peter T.
United States, New York
Memorial Sloan-kettering Cancer Center
Statistics
Citations: 81
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1016/j.eururo.2013.08.036
ISSN:
03022838
Research Areas
Cancer
Environmental
Health System And Policy
Mental Health
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative