Pathology--tumor location
MZB
What about for a positive margin?
Mel
ron
Mel...Many papers have been published on whether positive margins
influence recurrence. Some studies concluded they did not, more
studies concluded they did. Then the following paper was published.
It found that margin location does play some role role. Perhaps this
variable wasn't controlled in the earlier studies, this might help
explain why different conclusions were often reached...ron
BIOCHEMICAL FAILURE IN MEN FOLLOWING RADICAL RETROPUBIC PROSTATECTOMY:
IMPACT OF SURGICAL MARGIN STATUS AND LOCATION.
Journal of Urology. 172(1):129-132, July 2004.
PETTUS, JOSEPH A.; WEIGHT, CHRISTOPHER J.; THOMPSON, CLINTON J.;
MIDDLETON, RICHARD G.; STEPHENSON, ROBERT A.
Purpose: The significance of isolated positive apical surgical margins
in radical retropubic prostatectomy (RRP) specimens remains
controversial. We examine the effects of margin status and location on
biochemical recurrence rates in patients undergoing RRP.
Materials and Methods: Of 800 patients with RRP we identified 498
without pathological evidence of lymph node, seminal vesicle or
adjacent organ involvement and with at least 6 months of followup.
Patients were subdivided into apex only positive (AM+), nonapical
isolated positive (OM+), multiple positive (MM+) and negative (SM-)
surgical margins. The rate and interval to biochemical disease
recurrence were determined in each group. Univariate and multivariate
analysis as well as Kaplan-Meier curves were used to test differences
among these groups.
Results: Of the 498 men who met our inclusion criteria 400 were SM-,
28 were AM+, 57 were OM+ and 13 were MM+ at a median followup of 49,
59, 64 and 83 months, respectively. Biochemical recurrence rates for
SM-, AM+, OM+ and MM+ were 9.3%, 21.4%, 26.3% and 30.8%, respectively.
Median time to biochemical failure in the SM-, AM+, OM+ and MM+ groups
was 34, 19.5, 46.0 and 6.8 months, respectively. Biochemical
recurrence was not statistically different among the AM+, OM+ and MM+
groups. On univariate analysis AM+, OM+ and MM+ were significant
predictors of recurrence (p < 0.05, < 0.005, and <0.05, respectively).
On multivariate models only pretreatment prostate specific antigen and
OM+ were independent predictors of biochemical recurrence.
Conclusions: A positive surgical margin conveys increased risk for
biochemical recurrence. Patients with AM+ experienced biochemical
recurrence more frequently and rapidly than those with SM-. AM+
conveys a similar risk of recurrence compared with OM+ and MM+. Apical
margin status did not independently predict biochemical recurrence.
Steve Kramer
news:hktgss$od1$1...@news.eternal-september.org...
> Just curious: is one location any worse than another?
>
> What about for a positive margin?
-- skramer remarks
There possibly is, but I have never seen anything reported. Keep in mind
that the best anyone has ever done with regard to predictors is the Partin
Tables. And even those results span tens of percentages, not a lick of
which are of any consolation to the man who is on the wrong side of the
stats.
The only known criteria on which one may place his hopes are (1) whether the
tumor(s) was/were found totally within the prostate, (2) how close to
getting out of the prostate the cancers was, (3) the cancer actually getting
out, and (4)metasticizing somewhere else.
That said, if the only place it got out was a pinhole, there is a
possibility that there is such a small number of cancer cells that they did
not survive or will not survive what limited actions the immune system might
have upon it. It is worse for your chance that there was a pinhole escape,
but it really doesn't matter where it occurred and it is not a death
sentence.
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD 0.56 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
Casodex added daily 07/06
PSA undetectable since. Next Assay 02/04/10
Illegitimati non carborundum