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Su SH, Chang YH, Huang LK, Chu YC, Kan HC, Liu CY, Lin PH, Yu KJ, Wu CT, Pang ST, Chuang CK, Shao IH. Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy. TUMORI JOURNAL 2021; 108:270-277. [PMID: 33845702 DOI: 10.1177/03008916211007928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). METHODS We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. RESULTS Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 (p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) (p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. CONCLUSIONS In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.
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Affiliation(s)
- Shih-Huan Su
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Kang Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Cheng Chu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan.,Cancer Genome Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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