Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

• Published in: Asian journal of andrology Vol. 19; no. 4; pp. 468 - 472
• Main Authors: Yang, Rong, Cao, Kai, Han, Tao, Zhang, Yi-Feng, Zhang, Gu-Tian, Xu, Lin-Feng, Lian, Hui-Bo, Li, Xiao-Gong, Guo, Hong-Qian
• Format: Journal Article
• Language: English
• Published: China Medknow Publications and Media Pvt. Ltd 01.07.2017; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Aged; Aged, 80 and over; Antigens; Biopsy, Needle - statistics & numerical data; Bladder; Cancer surgery; Cancer therapies; Humans; Laparoscopy; Laparoscopy - methods; Magnetic Resonance Imaging; Male; Medical prognosis; Metastasis; Middle Aged; Neoplasm Grading - statistics & numerical data; Neoplasm Invasiveness; NMR; Nuclear magnetic resonance; Original; Pathology; Patient outcomes; Patients; Predictive Value of Tests; Prostate - pathology; Prostate cancer; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Robots; Software; Surgeons; Treatment Outcome; Urological surgery; Urology; 切除术; 前列腺癌; 手术; 神经; 腹腔镜; 评分; 阳性; 预测因子; United States > US; China
• ISSN: 1008-682X; 1745-7262
• DOI: 10.4103/1008-682X.173444

This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineurat invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis （P 〈 0.05）. Gleason score （odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431-3.653, P= 0.001）, perineural invasion （OR = 4.961, 95% CI = 2.656-9.270, P〈 0.001）, and number of positive cores （OR = 4.403, 95% CI = 1.878-10.325, P = 0.001） were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion （49.5%） was much higher than that with localized disease （17.8%）. In contrast, prostate volume showed a protective effect against positive surgical margin （OR = 0.572, 95% CI = 0.346-0.945, P = 0.029）. Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.