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Asimakopoulos AD, Annino F, Mugnier C, Lopez L, Hoepffner JL, Gaston R, Piechaud T. Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center. Surg Endosc 2020; 35:6731-6745. [PMID: 33289056 PMCID: PMC8599245 DOI: 10.1007/s00464-020-08177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022]
Abstract
Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Department of Urology, Clinique Saint Augustin, Bordeaux, France. .,Department of Surgical Sciences, Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
| | - Filippo Annino
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Unit of Urology, Ospedale San Donato, Arezzo, Italy
| | - Camille Mugnier
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Laurent Lopez
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | | | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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Zhang L, Wu B, Zha Z, Zhao H, Jiang Y, Yuan J. Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies. World J Surg Oncol 2018; 16:124. [PMID: 29970100 PMCID: PMC6029044 DOI: 10.1186/s12957-018-1433-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background and purpose Although numerous studies have shown that positive surgical margin (PSM) is linked to biochemical recurrence (BCR) in prostate cancer (PCa), the research results have been inconsistent. This study aimed to explore the association between PSM and BCR in patients with PCa following radical prostatectomy (RP). Materials and methods In accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, EMBASE and Wan Fang databases were searched for eligible studies from inception to November 2017. The Newcastle–Ottawa Scale was used to assess the risk of bias of the included studies. Meta-analysis was performed by using Stata 12.0. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. Results Ultimately, 41 retrospective cohort studies of high quality that met the eligibility criteria, comprising 37,928 patients (94–3294 per study), were included in this meta-analysis. The results showed that PSM was associated with higher BCR risk in both univariate analysis (pooled HR = 1.56; 95% CI 1.46, 1.66; p < 0.001) and multivariate analysis (pooled HR = 1.35; 95% CI 1.27, 1.43; p < 0.001). Moreover, no potential publication bias was observed among the included studies in univariate analysis (p-Begg = 0.971) and multivariate analysis (p-Begg = 0.401). Conclusions Our meta-analysis demonstrated that PSM is associated with a higher risk of BCR in PCa following RP and could serve as an independent prognostic factor in patients with PCa. Electronic supplementary material The online version of this article (10.1186/s12957-018-1433-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin Zhang
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
| | - Bin Wu
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Zhenlei Zha
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Hu Zhao
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Yuefang Jiang
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Jun Yuan
- Departments of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
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Zhang L, Wu B, Zha Z, Zhao H, Yuan J, Jiang Y, Yang W. Surgical margin status and its impact on prostate cancer prognosis after radical prostatectomy: a meta-analysis. World J Urol 2018; 36:1803-1815. [PMID: 29766319 PMCID: PMC6208659 DOI: 10.1007/s00345-018-2333-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background and purpose Positive surgical margins (PSMs) correlate with adverse outcomes in numerous solid tumours. However, the prognostic value of PSMs in prostate cancer (PCa) patients who underwent radical prostatectomy remains unclear. Herein, we performed a meta-analysis to evaluate the association between PSMs and the prognostic value for biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients. Materials and methods According to the PRISMA statement, online databases PubMed, EMBASE and Web of Science were searched to identify relevant studies published prior to February 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to evaluate the relationship between PSMs and PCa. Results Ultimately, 32 cohort studies that met the eligibility criteria and involved 141,222 patients (51–65,633 per study) were included in this meta-analysis. The results showed that PSMs were significantly predictive of poorer BRFS (HR = 1.35, 95% CI 1.28–1.48, p < 0.001), CSS (HR = 1.49, 95% CI 1.16–1.90, p = 0.001) and OS (HR = 1.11, 95% CI 1.02–1.20, p = 0.014). In addition, PSMs were significantly associated with higher risk of CSM (HR = 1.23, 95% CI 1.16–1.30, p < 0.001) and OM (HR = 1.09, 95% CI 1.02–1.16, p = 0.009) in patients with PCa. Conclusions Our study suggests that the presence of a histopathologic PSM is associated with the clinical outcomes BRFS, CSS, OS, CSM and OM in patients with PCa, and PSMs could serve as a poor prognostic factor for patients with PCa. Electronic supplementary material The online version of this article (10.1007/s00345-018-2333-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China.
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Yuefang Jiang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Wei Yang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
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Moschini M, Sharma V, Gandaglia G, Dell'Oglio P, Fossati N, Zaffuto E, Montorsi F, Briganti A, Karnes RJ. Long-term utility of adjuvant hormonal and radiation therapy for patients with seminal vesicle invasion at radical prostatectomy. BJU Int 2016; 120:69-75. [PMID: 27753192 DOI: 10.1111/bju.13683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer with seminal vesicle invasion (SVI; pT3b), as the published data are conflicting. PATIENTS AND METHODS Patients with SVI during RP and pelvic lymph node dissection at two major referral centres from 1986 to 2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were used to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence (BCR), cancer-specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients. RESULTS Overall, 3 279 patients with prostate cancer and SVI were included with a median follow-up of 148 months. Considering the whole SVI population, 1 387 (42%) received no adjuvant therapy, 1 179 (36%) received aHT, 461 (14.1%) received aRT, while 252 (7.7%) received both aHT and aRT. The 10-year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all P < 0.04). When only pT3bN0 patients were considered, aHT was a significant multivariate predictor of BCR [hazard ratio (HR) 0.50, P < 0.001), CSM (HR 0.62, P = 0.01) and OM (HR 0.75, P = 0.004). Conversely, aRT was not associated with survival outcomes (all P > 0.05). When only the subgroup pT3bN+ was considered, the use of aRT was related to an improvement in CSM (HR 0.65, P = 0.03) and OM (HR 0.78, P = 0.03). CONCLUSIONS aHT + aRT seems to be effective in pT3b patients. However, when stratified according to the presence of nodal metastases, aHT remains effective only in the node-negative subgroup, while aRT remains effective only in the node-positive subgroup. Further data including prospective trials are warranted to study the utility of adjuvant therapies in this setting.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.,Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Emanuele Zaffuto
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
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Inoue T, Kinoshita H, Terada N, Kobayashi T, Yamasaki T, Matsui Y, Kamba T, Inui H, Sugi M, Matsuda T, Ogawa O. Evaluation of prognostic factors after radical prostatectomy in pT3b prostate cancer patients in Japanese population. Jpn J Clin Oncol 2015; 45:780-4. [PMID: 25981623 DOI: 10.1093/jjco/hyv077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/24/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of the current study was to evaluate prognostic factors after radical prostatectomy for prostate cancer patients with seminal vesicle invasion (pT3b) in the Japanese population. METHODS Between January 2005 and December 2011, 814 patients underwent radical prostatectomy without neoadjuvant hormonal therapy at our institutions. Among these patients, 31 were (3.8%) presented with pT3b. Kaplan-Meier method was used to determine biochemical recurrence-free, disease-specific and overall survival of patients in this group. Proportional hazards models were used to determine predictors of biochemical recurrence-free survival. RESULTS The median follow-up period was 60 months (range, 9-108 months). During follow-up, 23 patients (74.2%) experienced biochemical recurrence, and the overall 3-year probability of freedom from biochemical recurrence was 29%. However, only one patient died of the disease, and the 5-year overall survival was 92%. In multivariate analysis, age at the time of surgery was the only significant variable for predicting biochemical recurrence after radical prostatectomy (P = 0.0356, hazard ratio = 0.92, 95% confidence interval = 0.851-0.994). CONCLUSIONS Patients with seminal vesicle invasion of pathological specimens after radical prostatectomy have high biochemical recurrence, but the survival was favorable especially in light of current multimodal treatment regimens. However, patients with younger age at the time of surgery, in particular, should receive multimodal treatments to improve their outcome.
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Affiliation(s)
- Takahiro Inoue
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Naoki Terada
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Toshinari Yamasaki
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Yoshiyuki Matsui
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Tomomi Kamba
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
| | - Hidekazu Inui
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Motohiko Sugi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Sakyoku, Kyoto
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