Variation in Positive Surgical Margin Status Following Radical Prostatectomy for pT2 Prostate Cancer
Tan WS, Krimphove M, Cole A, Berg S, Marchese M, Lipsitz S, Loppenberg B, Nabi J, Abdollah F, Choueiri T, Kibel A, Sooriakumaran P, and Trinh QD. Variation in Positive Surgical Margin Status Following Radical Prostatectomy for pT2 Prostate Cancer. J Clin Urol 2019; 12(1):42-44.
J Clin Urol
Background: Positive surgical margin (PSM) following radical prostatectomy for pT2 prostate cancer is considered a surgical quality metric. We evaluated patient, institutional, surgical approach and cancer-specific factors associated with PSM variability. Methods: A total of 45,426 men from 1,152 institutions with pT2 prostate cancer following radical prostatectomy were identified using the National Cancer Database (2010-2015). Patient demographics and comorbidity, socioeconomic status, and institutional information, cancerspecific variables and type of surgical approach were extracted. Multilevel hierarchical mixed effects logistic regression model was performed to determine the factors associated with a risk of PSM and their contribution to a PSM status. Results: Median PSM rate of 8.5% (IQR: 5.2-13.0%, range: 0-100%). Robotic (OR: 0.90, 95% CI: 0.83-0.99) and laparoscopic (OR: 0.74, 95% CI: 0.64-0.90) surgical approach, academic institution (OR: 0.87, 95% CI: 0.76-1.00) and high institution surgical volume (>297 cases [OR: 0.83, 95% CI: 0.70-0.99) were independently associated with a lower PSM. Black men (OR: 1.13, 95% CI: 1.01-1.26) and adverse cancer specific features (PSA 10-20, PSA >20, cT3 stage, Gleason 7, 8, 9-10; all p>0.01) were independently associated with a higher PSM. Multilevel hierarchical logistic regression model accounted for 24.9% of PSM variation. Patient-specific, institution-specific and cancerspecific factors accounted for 2.3%, 3.9% and 15.6% of the variation. Conclusion: Cancer-specific factors account for 15.2% of PSM variation with the remaining 84.8% of PSM variation due to patient, institution and other factors. Non-cancerspecific factors represent potentially addressable factors which are important for policy makers in their efforts to improve patient outcome. (Table Presented).