Primary gleason grade 4 at the positive margin is associated with metastasis and death among patients with gleason 7 prostate cancer undergoing radical prostatectomy

Boyd R. Viers, William R. Sukov, Matthew T. Gettman, Laureano J. Rangel, Eric J. Bergstralh, Igor Frank, Matthew K. Tollefson, R. Houston Thompson, Stephen A. Boorjian, Robert Jeffrey Karnes

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Abstract

Background The presence of a positive surgical margin (PSM) at radical prostatectomy (RP) has been linked to an increased risk of biochemical recurrence and receipt of secondary therapy; however, its association with other oncologic end points remains controversial.

Design, setting, and participants We identified 1036 patients who underwent RP between 1996 and 2002. A single uropathologist re-reviewed all specimens noted to have a PSM to record GG at the margin.

Outcome measurements and statistical analysis Survival was estimated using the Kaplan-Meier method. Cox models were used to analyze the association of margin primary GG with outcome.

Results and limitations Overall, 338 men (33%) had a PSM; of those, 242 had PSM GG3 and 96 had PSM GG4. Median postoperative follow-up was 13 yr. Compared with men with PSM GG3 or a negative SM, we noted that men with PSM GG4 had significantly worse 15-yr systemic progression-free survival (74% vs 90% vs 93%, respectively; p < 0.001) and cancer-specific survival (86% vs 96% vs 97%, respectively; p = 0.002). On multivariable analysis, the presence of PSM GG4 was associated with increased risks of systemic progression (hazard ratio [HR]: 2.77; p = 0.003) and death from PCa (HR: 3.93; p = 0.02) among men with a PSM. Limitations include the relatively small rate of disease recurrence.

Conclusions PSM primary GG4 was independently associated with adverse oncologic outcomes among men with GS7 PCa. Pending external validation, GG at the PSM may be considered for inclusion in pathologic reports and risk stratification following RP.

Patient summary Among patients with Gleason grade 7 prostate cancer and a positive surgical margin at the time of prostatectomy, we found that higher Gleason grade at the margin was associated with worse oncologic outcomes.

Original languageEnglish (US)
Pages (from-to)1116-1124
Number of pages9
JournalEuropean Urology
Volume66
Issue number6
DOIs
StatePublished - Dec 1 2014

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Prostatectomy
Prostatic Neoplasms
Neoplasm Metastasis
Margins of Excision
Recurrence
Survival Analysis
Proportional Hazards Models
Disease-Free Survival

Keywords

  • Cancer mortality
  • Gleason score 7
  • Positive surgical margin
  • Prostate cancer
  • Radical prostatectomy
  • Systemic progression

ASJC Scopus subject areas

  • Urology

Cite this

Primary gleason grade 4 at the positive margin is associated with metastasis and death among patients with gleason 7 prostate cancer undergoing radical prostatectomy. / Viers, Boyd R.; Sukov, William R.; Gettman, Matthew T.; Rangel, Laureano J.; Bergstralh, Eric J.; Frank, Igor; Tollefson, Matthew K.; Thompson, R. Houston; Boorjian, Stephen A.; Karnes, Robert Jeffrey.

In: European Urology, Vol. 66, No. 6, 01.12.2014, p. 1116-1124.

Research output: Contribution to journalArticle

Viers, Boyd R. ; Sukov, William R. ; Gettman, Matthew T. ; Rangel, Laureano J. ; Bergstralh, Eric J. ; Frank, Igor ; Tollefson, Matthew K. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Karnes, Robert Jeffrey. / Primary gleason grade 4 at the positive margin is associated with metastasis and death among patients with gleason 7 prostate cancer undergoing radical prostatectomy. In: European Urology. 2014 ; Vol. 66, No. 6. pp. 1116-1124.
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abstract = "Background The presence of a positive surgical margin (PSM) at radical prostatectomy (RP) has been linked to an increased risk of biochemical recurrence and receipt of secondary therapy; however, its association with other oncologic end points remains controversial.Design, setting, and participants We identified 1036 patients who underwent RP between 1996 and 2002. A single uropathologist re-reviewed all specimens noted to have a PSM to record GG at the margin.Outcome measurements and statistical analysis Survival was estimated using the Kaplan-Meier method. Cox models were used to analyze the association of margin primary GG with outcome.Results and limitations Overall, 338 men (33{\%}) had a PSM; of those, 242 had PSM GG3 and 96 had PSM GG4. Median postoperative follow-up was 13 yr. Compared with men with PSM GG3 or a negative SM, we noted that men with PSM GG4 had significantly worse 15-yr systemic progression-free survival (74{\%} vs 90{\%} vs 93{\%}, respectively; p < 0.001) and cancer-specific survival (86{\%} vs 96{\%} vs 97{\%}, respectively; p = 0.002). On multivariable analysis, the presence of PSM GG4 was associated with increased risks of systemic progression (hazard ratio [HR]: 2.77; p = 0.003) and death from PCa (HR: 3.93; p = 0.02) among men with a PSM. Limitations include the relatively small rate of disease recurrence.Conclusions PSM primary GG4 was independently associated with adverse oncologic outcomes among men with GS7 PCa. Pending external validation, GG at the PSM may be considered for inclusion in pathologic reports and risk stratification following RP.Patient summary Among patients with Gleason grade 7 prostate cancer and a positive surgical margin at the time of prostatectomy, we found that higher Gleason grade at the margin was associated with worse oncologic outcomes.",
keywords = "Cancer mortality, Gleason score 7, Positive surgical margin, Prostate cancer, Radical prostatectomy, Systemic progression",
author = "Viers, {Boyd R.} and Sukov, {William R.} and Gettman, {Matthew T.} and Rangel, {Laureano J.} and Bergstralh, {Eric J.} and Igor Frank and Tollefson, {Matthew K.} and Thompson, {R. Houston} and Boorjian, {Stephen A.} and Karnes, {Robert Jeffrey}",
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T1 - Primary gleason grade 4 at the positive margin is associated with metastasis and death among patients with gleason 7 prostate cancer undergoing radical prostatectomy

AU - Viers, Boyd R.

AU - Sukov, William R.

AU - Gettman, Matthew T.

AU - Rangel, Laureano J.

AU - Bergstralh, Eric J.

AU - Frank, Igor

AU - Tollefson, Matthew K.

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Karnes, Robert Jeffrey

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background The presence of a positive surgical margin (PSM) at radical prostatectomy (RP) has been linked to an increased risk of biochemical recurrence and receipt of secondary therapy; however, its association with other oncologic end points remains controversial.Design, setting, and participants We identified 1036 patients who underwent RP between 1996 and 2002. A single uropathologist re-reviewed all specimens noted to have a PSM to record GG at the margin.Outcome measurements and statistical analysis Survival was estimated using the Kaplan-Meier method. Cox models were used to analyze the association of margin primary GG with outcome.Results and limitations Overall, 338 men (33%) had a PSM; of those, 242 had PSM GG3 and 96 had PSM GG4. Median postoperative follow-up was 13 yr. Compared with men with PSM GG3 or a negative SM, we noted that men with PSM GG4 had significantly worse 15-yr systemic progression-free survival (74% vs 90% vs 93%, respectively; p < 0.001) and cancer-specific survival (86% vs 96% vs 97%, respectively; p = 0.002). On multivariable analysis, the presence of PSM GG4 was associated with increased risks of systemic progression (hazard ratio [HR]: 2.77; p = 0.003) and death from PCa (HR: 3.93; p = 0.02) among men with a PSM. Limitations include the relatively small rate of disease recurrence.Conclusions PSM primary GG4 was independently associated with adverse oncologic outcomes among men with GS7 PCa. Pending external validation, GG at the PSM may be considered for inclusion in pathologic reports and risk stratification following RP.Patient summary Among patients with Gleason grade 7 prostate cancer and a positive surgical margin at the time of prostatectomy, we found that higher Gleason grade at the margin was associated with worse oncologic outcomes.

AB - Background The presence of a positive surgical margin (PSM) at radical prostatectomy (RP) has been linked to an increased risk of biochemical recurrence and receipt of secondary therapy; however, its association with other oncologic end points remains controversial.Design, setting, and participants We identified 1036 patients who underwent RP between 1996 and 2002. A single uropathologist re-reviewed all specimens noted to have a PSM to record GG at the margin.Outcome measurements and statistical analysis Survival was estimated using the Kaplan-Meier method. Cox models were used to analyze the association of margin primary GG with outcome.Results and limitations Overall, 338 men (33%) had a PSM; of those, 242 had PSM GG3 and 96 had PSM GG4. Median postoperative follow-up was 13 yr. Compared with men with PSM GG3 or a negative SM, we noted that men with PSM GG4 had significantly worse 15-yr systemic progression-free survival (74% vs 90% vs 93%, respectively; p < 0.001) and cancer-specific survival (86% vs 96% vs 97%, respectively; p = 0.002). On multivariable analysis, the presence of PSM GG4 was associated with increased risks of systemic progression (hazard ratio [HR]: 2.77; p = 0.003) and death from PCa (HR: 3.93; p = 0.02) among men with a PSM. Limitations include the relatively small rate of disease recurrence.Conclusions PSM primary GG4 was independently associated with adverse oncologic outcomes among men with GS7 PCa. Pending external validation, GG at the PSM may be considered for inclusion in pathologic reports and risk stratification following RP.Patient summary Among patients with Gleason grade 7 prostate cancer and a positive surgical margin at the time of prostatectomy, we found that higher Gleason grade at the margin was associated with worse oncologic outcomes.

KW - Cancer mortality

KW - Gleason score 7

KW - Positive surgical margin

KW - Prostate cancer

KW - Radical prostatectomy

KW - Systemic progression

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