Prognostic Value of Microscopic Linear Length and Gleason Score of the Tumor at Positive Margin in Robot Assisted Radical Prostatectomy Specimens: A Study of 127 Whole Mount Cases
Umar B, Alhamar M, Taneja K, Diaz-Insua M, Williamson SR, and Gupta N. Prognostic Value of Microscopic Linear Length and Gleason Score of the Tumor at Positive Margin in Robot Assisted Radical Prostatectomy Specimens: A Study of 127 Whole Mount Cases. Lab Invest 2018; 98:396.
Background: Localized prostate cancers (PCa) are usually treated with radical prostatectomy (RP) to improve cancer specific survival. Presence of positive surgical margins (PSM) is an independent prognostic factor as well as a reason for adjuvant therapy. Currently there is heterogeneous data about the significance of extent of PSM. Some studies have used the term focal and extensive and others have done exact quantification of the PSM. Some studies have questioned if extent of positive surgical margin provides any additional prognostic significance. On this background, we wanted to assess the correlation of linear length of PSM in RP specimens with the risk of biochemical recurrence (BCR). In addition, we also evaluated other pathologic parameters such as Gleason score (GS) of the tumor at the positive margin, location of positive margin, and positivity within or outside of the prostatic capsule. Design: We reviewed 127 cases of PCa with PSM on patients who underwent RP at our institution between 2012-2014. Microscopic linear length (LL) of positive margin was measured and cases were stratified as follows, LL3mm. Following parameters were also assessed: Gleason score and stage of the main tumor, tumor volume, location of positive margin, GS at the positive margin, capsular incision with positive margin (CI) versus extraprostatic extension with positive margin (EPE-M). Results: After pathologic review, 127 patients were grouped as follows, 1. 26 with LL of3. During the 4.5 years of follow up 0, 9, 20 patients had BCR in each group respectively. Our data suggest that LL is associated with an increased risk of BCR (p