.: ORİJİNAL ARAŞTIRMA
Assessment of Preoperative Predictive Factors for Positive Surgical Margins in Patients with Low or Intermediate Risk Prostate Cancer Who Underwent Retropubic Radical Prostatectomy
Radikal Prostatektomi Uygulanan Düşük ya da Orta Riskli Hastalarda Operasyon Öncesi Prediktif Faktörlerin Pozitif Cerrahi Sınır Gelişmesi Açısından Değerlendirilmesi
J Reconstr Urol. 2019;9(3):79-84
doi: 10.5336/urology.2019-72536
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Positive surgical margins after radical prostatectomy is important due to increased risk of biochemical recurrence. Preoperative clinical stage, prostate specific antigen (PSA) value and the Gleason Score are the predictors of surgical margin status. In this study we aimed to assess the effects of preoperative variables on surgical margin positivity in patients with low or intermediate risk. Material and Methods: Preoperative clinical stage, PSA value, prostate volume and variables obtained from prostate biopsies of 73 patients who were grouped in low or intermediate risk according to D'Amico criteria (Clinical satge≤ T2b, PSA<10 ng/dl, Gleason Score ≤ 7) were compared with regard to surgical margin positivity status retrospectively. Results: The rate of the patients with positive surgical margins was 23.3%. The mean prostate volume was 84.91 ml±21.43 and 56.05 ml±18.42 in negative and positive surgical magrin groups, respectively (p=0.001). While 14.6% of the patients with a PSA level <10 ng/dl had positive surgical margins, this rate was 34.4% in the patients with a PSA level of 10-20 ng/dl. (p=0.05). Increased numbers of positive cores in prostate biopsy were related with positive surgical margins (p=0.001). In multivariate analysis, only, prostate volumes less than 70 ml was found to be statistically significant (p=0.023). Conclusion: Smaller prostate volumes less than 70 ml. increase the risk of positive surgical margins in patients with low or intermediate risk.
Keywords: Margins of excision; prostatic cancer
Objective: Positive surgical margins after radical prostatectomy is important due to increased risk of biochemical recurrence. Preoperative clinical stage, prostate specific antigen (PSA) value and the Gleason Score are the predictors of surgical margin status. In this study we aimed to assess the effects of preoperative variables on surgical margin positivity in patients with low or intermediate risk. Material and Methods: Preoperative clinical stage, PSA value, prostate volume and variables obtained from prostate biopsies of 73 patients who were grouped in low or intermediate risk according to D'Amico criteria (Clinical satge≤ T2b, PSA<10 ng/dl, Gleason Score ≤ 7) were compared with regard to surgical margin positivity status retrospectively. Results: The rate of the patients with positive surgical margins was 23.3%. The mean prostate volume was 84.91 ml±21.43 and 56.05 ml±18.42 in negative and positive surgical magrin groups, respectively (p=0.001). While 14.6% of the patients with a PSA level <10 ng/dl had positive surgical margins, this rate was 34.4% in the patients with a PSA level of 10-20 ng/dl. (p=0.05). Increased numbers of positive cores in prostate biopsy were related with positive surgical margins (p=0.001). In multivariate analysis, only, prostate volumes less than 70 ml was found to be statistically significant (p=0.023). Conclusion: Smaller prostate volumes less than 70 ml. increase the risk of positive surgical margins in patients with low or intermediate risk.
Keywords: Margins of excision; prostatic cancer
ÖZET
Amaç: Radikal prostatektomi sonrası cerrahi sınırların pozitif olması biyokimyasal rekürrens riskini artırması nedeniyle önemlidir. Operasyon öncesi klinik evre, PSA değeri ve Gleason Skoru pozitif cerrahi sınırlar açısından belirleyici özelliktedir. Bu çalışmada, düşük ve orta risk özellikleriyle radikal prostatektomi uygulanan hastalarda operasyon öncesi verilerin cerrahi sınır pozitifliği üzerine olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Retrospektif olarak D'Amico kriterlerine göre düşük ve orta risk grubunda (klinik evre ≤ T2b, PSA<10 ng/dl, Gleason Skoru ≤ 7) olan 73 hastanın ameliyat öncesi klinik evre, PSA değeri, prostat hacmi ve prostat biyopsisinden elde edilen verileri pozitif cerrahi sınır saptanmasına göre karşılaştırıldı. Bulgular: Pozitif cerrahi sınır saptanan hastaların oranı %23,3 idi. Ortalama prostat hacmi negatif cerrahi sınır grubunda 84,91 ml±21,43 ve pozitif cerrahi sınır grubunda 56,05 ml±18,42 olarak bulundu (p=0,001). PSA seviyesi 10 ng/dl'den düşük olan hastalarda cerrahi sınır pozitifliği oranı %14,6 bulunurken, PSA seviyesi 10-20 ng/dl arasında olan hastalarda bu oran %34,4 olarak bulundu (p=0,05). Prostat biyopsisinde artmış pozitif kor sayıları pozitif cerrahi sınır ile ilişkili bulundu (p=0,001). Çoklu değişken analizinde ise sadece prostat hacminin 70 ml'den az olması istatistiksel olarak anlamlı bulundu (p=0,023). Sonuç: Düşük veya orta risk grubunda olan 70 ml'den küçük prostat hacimli hastalarda cerrahi sınır pozitifliği riski artmıştır.
Anahtar Kelimeler: Eksizyon siniri; prostatik kanser
Amaç: Radikal prostatektomi sonrası cerrahi sınırların pozitif olması biyokimyasal rekürrens riskini artırması nedeniyle önemlidir. Operasyon öncesi klinik evre, PSA değeri ve Gleason Skoru pozitif cerrahi sınırlar açısından belirleyici özelliktedir. Bu çalışmada, düşük ve orta risk özellikleriyle radikal prostatektomi uygulanan hastalarda operasyon öncesi verilerin cerrahi sınır pozitifliği üzerine olan etkisini araştırmayı amaçladık. Gereç ve Yöntemler: Retrospektif olarak D'Amico kriterlerine göre düşük ve orta risk grubunda (klinik evre ≤ T2b, PSA<10 ng/dl, Gleason Skoru ≤ 7) olan 73 hastanın ameliyat öncesi klinik evre, PSA değeri, prostat hacmi ve prostat biyopsisinden elde edilen verileri pozitif cerrahi sınır saptanmasına göre karşılaştırıldı. Bulgular: Pozitif cerrahi sınır saptanan hastaların oranı %23,3 idi. Ortalama prostat hacmi negatif cerrahi sınır grubunda 84,91 ml±21,43 ve pozitif cerrahi sınır grubunda 56,05 ml±18,42 olarak bulundu (p=0,001). PSA seviyesi 10 ng/dl'den düşük olan hastalarda cerrahi sınır pozitifliği oranı %14,6 bulunurken, PSA seviyesi 10-20 ng/dl arasında olan hastalarda bu oran %34,4 olarak bulundu (p=0,05). Prostat biyopsisinde artmış pozitif kor sayıları pozitif cerrahi sınır ile ilişkili bulundu (p=0,001). Çoklu değişken analizinde ise sadece prostat hacminin 70 ml'den az olması istatistiksel olarak anlamlı bulundu (p=0,023). Sonuç: Düşük veya orta risk grubunda olan 70 ml'den küçük prostat hacimli hastalarda cerrahi sınır pozitifliği riski artmıştır.
Anahtar Kelimeler: Eksizyon siniri; prostatik kanser
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