519 Gleason score evaluated at the level of positive surgical margin could help to predict biochemical recurrence rate after radical prostatectomy

Title

519

Gleason score evaluated at the level of positive surgical margin could help to predict biochemical recurrence rate after radical prostatectomy Eur Urol Suppl 2015;14/2;e519          

Print! Print!

Susperregui J. 1 , Pierry C.2 , Bonhomme B. 2 , Pasticier G.1 , Bernhard J-C.1 , Yacoub M. 2 , Karavitakis M. 3 , Ballanger P. 1 , Ferrière J-M. 1 , Robert G.Y. 1 1 Bordeaux

Pellegrin University Hospital, Dept. of Urology, Bordeaux, France, 2 Bordeaux Pellegrin University Hospital, Dept. of Pathology,

Bordeaux, France, 3 Bordeaux Pellegrin University Hospital, Dept. of Biostatistics and Epidemiology, Bordeaux, France INTRODUCTION & OBJECTIVES: Multiple parameters may impact the biochemical recurrence rate (BRR) after radical prostatectomy (RP) one of them being the presence of a positive surgical margin (PSM). The length of PSM is crucial but results are controversial regarding the aggressiveness of cancer cells at the level of PSM. Our aim was to assess the influence of the Gleason score at the level of PSM on BRR. MATERIAL & METHODS: We conducted a retrospective study on a prospective clinical database including all RP performed in our department from January 2007 to November 2011. A total of 658 RP of which 106 had PSM (16%) were included. Clinical data were prospectively collected but all the RP specimens with PSM were reviewed to determine the Gleason score at the level of PSM. Two experienced pathologists independently scored the Gleason score at the level of PSM and a consensus was found in case of discrepancy. All parameters susceptible to influence the BRR were studied. Statistical analysis was performed using the SPSS software including association tests (ANOVA, χ 2 ), drawing of Kaplan Meier curves, and Cox regression model. RESULTS: Five patients were excluded from statistical analysis: 2 for premature death not related with prostate cancer (stroke, myocardial infarction), 1 for lack of histological material (not found in the storage system) and 2 for negative surgical margins after reviewing the slides. A total of 101 patients were included in statistical analysis. With a mean and median follow-up of 38 and 36 months (range 24 to 84), biochemical recurrence was reported in 32 patients (BRR = 31.7%). Gleason score at the level of PSM was 6 in 55 cases, 7 (3+4) in 28, 7(4+3) in 8 and >7 in 10. Gleason score at PSM was significantly associated with BRR (ANOVA, p = 0.008). Univariate analysis showed that Gleason score at PSM (p = 0.013) was predictor of biochemical recurrence (figure 1). Other predictors of biochemical recurrence in uni-variate analysis were initial PSA (p < 0.0001), final Gleason score (p < 0.001), length of PSM (p = 0.013) and seminal vesicule invasion (p < 0.0001). Independent predictors of biochemical recurrence in multivariate analysis were PSA > 10 ng/mL (p = 0.001) and length of PSM > 3 mm (p = 0.001).  Figure 1: Kaplan Meier estimates of biochemical recurrence free survival according to the Gleason score at the level of positive surgical margin (gleason 6 = blue, gleason 7 = green, gleason > 7 = brown)

file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/519.html[19/02/2015 08:15:06]

Title

CONCLUSIONS: In this retrospective study Gleason score at the level of PSM was predictor of biochemical recurrence in uni- but not in multi-variate analysis. Longer follow-up or larger study population could improve the statistical power of this study but prospective studies have to be conducted before Gleason score at PSM could be considered for adjuvant treatment decision-making.

file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/519.html[19/02/2015 08:15:06]