Korean J Urol.  2009 Oct;50(10):955-962.

Oncologic Outcome following Laparoscopic Radical Prostatectomy and the Difference in Oncologic Outcomes according to the Site of the Positive Margin: Comparison of the Apical Positive Margin with the Non-Apical Positive Margin

• Ha US
• Kim SI
• Kim SJ
• Cho HJ
• Hong SH
• Lee JY
• Kim JC
• Kim SW
• Hwang TK

Abstract

PURPOSE
The aim of this study was to analyze oncologic outcomes based on 7 years of consecutive experience with laparoscopic radical prostatectomy (LRP) and to assess the prognostic difference between an apical positive margin and a non-apical positive margin.
MATERIALS AND METHODS
We reviewed 202 patients who underwent LRP between July 2001 and July 2007 (pathologic stage: T2-T3b, without any adjunctive therapy). Biochemical recurrence (bR) was defined as two consecutive prostate-specific antigen (PSA) values greater than 0.2 ng/ml. We analyzed the differences in bR among the negative margin group (N), the apical positive margin group (A), and the non-apical positive margin group (NA) and factors predicting bR. RESULTS: Overall 3-year probability of bR-free survival (bRFS) was 78% (pT2, 83.7%; pT3, 60.9%). For low-, intermediate-, and high-risk cancer, 3-year bRFS was 94.7%, 82.8%, and 60.7%, respectively. Of the 155 men who had negative and single-site positive margins, the numbers in the N, A, and NA groups were 108, 19, and 28, respectively. bR rates for the N, A, and NA groups were 14.8%, 36.8%, and 46.4%, respectively. Kaplan-Meier curves showed that a positive surgical margin had a significant higher bR compared with the N group; however, the A group experienced a similar bRFS compared with the NA group (p=0.613). Multivariate Cox proportional hazards analysis indicated no significant difference of effect on time to bR between the A and NA groups (hazard ratio=1.213; 95% confidence interval: 0.482-3.052).
CONCLUSIONS
Our results were almost identical to previous reports of radical prostatectomy in pT2 disease. With increasing experience, we could expect improved oncologic outcomes. In comparison with the NA group, the A group did not show a significant prognostic difference.

Keyword

Prostatectomy; Recurrence; Laparoscopy

MeSH Terms

Humans
Laparoscopy
Male
Prostate-Specific Antigen
Prostatectomy
Recurrence
Prostate-Specific Antigen

Figure

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  Fig. 1 Kaplan-Meier curve estimates of biochemical recurrence-free survival for patients treated with laparoscopic radical prostatectomy according to preoperative risk group.

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  Fig. 2 Kaplan-Meier curve with log-rank test estimates of biochemical recurrence-free survival for patients treated with laparoscopic radical prostatectomy according to margin status (overall comparisons, p=0.004). Pairwise comparison: N vs. A, p=0.031; N vs. NA, p=0.001; A vs. NA, p=0.613. N: negative surgical margin, A: apical positive margin, NA: non-apical positive margin.

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