Tumor Biological Feature and Its Association with Positive Surgical Margins and Apical Margins after Radical Prostatectomy in Non-Metastasis Prostate Cancer

Purpose: We assessed clinical and tumor biological features and evaluated their association with positive surgical margins (PSMs) and positive apical margins (PAMs) variability after radical prostatectomy (RP) in men with non-metastasis prostate cancer (nmPCa) in our institute. Patients and methods: During the period from January 2013 to December 2017, clinical and pathological data were collected in 200 patients with nmPCa undergoing RP in the Urological department of Peking University Cancer Hospital & Institute. Surgical and apical margins were stated negative and positive, separately. A dichotomous logistic regression model was used to assess clinical and tumor biological features including age, total prostate volume (TPV), biopsy positive cores (BPC), D'Amico risk grade, tumor clinical stage, International Society of Urologic Pathology (ISUP) grade, tPSA, f/t and pelvic lymph nodes (PLN) invasion, and their association with PSMs and PAMs was evaluated. Results: Overall, men with nmPCa in this study had a high ISUP grade (58.5% grade 3-5), high risk grade (89.4%) and high clinical T stage (56% cT3-4). PSMs were detected in 106 patients; the rate of PSMs was 53%. Among patients with PSMs, 83% were PAMs; the overall rate of PAMs was 44%. Among patients with PSMs, high risk (OR, 1.439; p = 0.023), cT3a (OR, 1.737; p = 0.045), cT3b (OR, 5.286; p < 0.001), cT4 (OR, 6.12; p < 0.001), ISUP Grade 4 (OR, 2; p = 0.034) and Grade 5 (OR, 6.167; p < 0.001) and PLN invasion (OR, 6; p = 0.019) were strongly associated with PSMs using a dichotomous logistic regression univariable model, and high risk (OR, 6; p = 0.019), cT3a (OR, 5.116; p = 0.048), cT3b (OR, 9.194; p = 0.008), cT4 (OR, 4.58; p = 0.01), ISUP Grade 4 (OR, 7.04; p = 0.035), Grade 5 (OR, 16.514; p = 0.002) and PLN invasion (OR, 5.516; p = 0.03) were independently associated with PSMs by using multivariable analysis. Among patients with PAMs, cT3b (OR, 2.667; p = 0.004), cT4 (OR, 3; p = 0.034) and proportion of BPC (OR, 4.594; p = 0.027) were strongly associated with PAMs by using a dichotomous logistic regression univariable model, and cT3b (OR, 3.899; p = 0.02), cT4 (OR, 2.8; p = 0.041) and proportion of BPC (OR, 5.247; p = 0.04) were independently associated with PSMs by using multivariable analysis. Conclusions: Patients with nmPCa in our institute had high risk, high ISUP grade and high clinical stage. Tumor biological factors were strongly associated with PSMs and PAMs, and PLN invasion was independently associated with PSMs. The risk factors influenced the status of surgical margins, and apical margins were different.

Automated summary

In patients with non-metastatic prostate cancer, high risk, high ISUP grade, and high clinical stage were observed. Tumor biological factors had strong associations with PSMs and PAMs, while pelvic lymph node invasion was independently associated with PSMs. Risk factors significantly influenced surgical margins status, showing differences in apical margins.