Impact of Gleason score of the tumor at the positive surgical margin as a prognostic factor

Kurose,Hirofumi; Ueda,Kosuke; Ogasawara,Naoyuki; Chikui,Katsuaki; Nakiri,Makoto; Nishihara,Kiyoaki; Matsuo,Mitsunori; Suekane,Shigetaka; Kusano,Hironori; Akiba,Jun; Yano,Hirohisa; Igawa,Tsukasa

doi:10.3892/mco.2022.2515

Impact of Gleason score of the tumor at the positive surgical margin as a prognostic factor

Authors:
- Hirofumi Kurose
- Kosuke Ueda
- Naoyuki Ogasawara
- Katsuaki Chikui
- Makoto Nakiri
- Kiyoaki Nishihara
- Mitsunori Matsuo
- Shigetaka Suekane
- Hironori Kusano
- Jun Akiba
- Hirohisa Yano
- Tsukasa Igawa
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Affiliations: Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan, Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
Published online on: February 10, 2022 https://doi.org/10.3892/mco.2022.2515
Article Number: 82
Copyright: © Kurose et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Although numerous studies have reported that a positive surgical margin (PSM) is the most important predictive factor for biochemical recurrence (BCR) of prostate cancer (PCa), only a small number of studies have evaluated the predictive value of the Gleason score (GS) of the tumor at the margin in radical prostatectomy (RP). The present study aimed to investigate the preoperative factors that predict PSM and the significant predictive factors for BCR in cases with PSM. In addition, it was examined whether documenting the GS of the tumor at the margin in pathological reports is useful as a predictive factor for BCR. Data of 241 patients with PCa who underwent RP at Kurume University Hospital (Kurume, Japan) between January 2007 and December 2011 were retrospectively reviewed. The median follow‑up period was 72 months and 122 patients had at least one PSM. The time to BCR was significantly shorter in patients with PSM than in those with a negative surgical margin. Multivariate analysis demonstrated that >10 ng/ml prostate‑specific antigen at diagnosis (P=0.024) and >25% positive core at biopsy (P=0.041) were independent prognostic preoperative factors for PSM. The GS of the tumor at the margin was equal, lower and higher than those of the main tumor in 74 (60.7%), 16 (13.1%) and 32 (26.2%) RPs, respectively. The BCR rates were 35.7, 55.1 and 82.1% in patients whose GS of the tumor at the margin was 6, 7 and 8‑10, respectively (P=0.0017). The GS of the tumor at the PSM (P=0.038) and anatomic location of the PSM (P=0.04) were identified as independent prognostic preoperative factors for BCR, whereas the GS of the main tumor and margin length were not. These results suggest that documenting the GS at the margin in pathological reports is useful as a predictive factor for BCR.

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1	Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, et al: EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 65:124–137. 2014.PubMed/NCBI View Article : Google Scholar
2	Nichol AM, Warde P and Bristow RG: Optimal treatment of intermediate-risk prostate carcinoma with radiotherapy: Clinical and translational issues. Cancer. 104:891–905. 2005.PubMed/NCBI View Article : Google Scholar
3	Lowrance WT, Eastham JA, Savage C, Maschino AC, Laudone VP, Dechet CB, Stephenson RA, Scardino PT and Sandhu JS: Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J Urol. 187:2087–2092. 2012.PubMed/NCBI View Article : Google Scholar
4	Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW and Scardino PT: Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol. 167:528–534. 2002.PubMed/NCBI View Article : Google Scholar
5	Stephenson AJ, Kattan MW, Eastham JA, Dotan ZA, Bianco FJ Jr, Lilja H and Scardino PT: Defining biochemical recurrence of prostate cancer after radical prostatectomy: A proposal for a standardized definition. J Clin Oncol. 24:3973–3978. 2006.PubMed/NCBI View Article : Google Scholar
6	D'Amico AV, Chen MH, Roehl KA and Catalona WJ: Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 351:125–135. 2004.PubMed/NCBI View Article : Google Scholar
7	D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ and Wein A: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 280:969–974. 1998.PubMed/NCBI View Article : Google Scholar
8	Horiguchi A, Nakashima J, Horiguchi Y, Nakagawa K, Oya M, Ohigashi T, Marumo K and Murai M: Prediction of extraprostatic cancer by prostate specific antigen density, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer. Prostate. 56:23–29. 2003.PubMed/NCBI View Article : Google Scholar
9	Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, Muramoto M, Reuter VE, Wheeler TM and Scardino PT: Predicting the presence and side of extracapsular extension: A nomogram for staging prostate cancer. J Urol. 171:1844–1849. 2004.PubMed/NCBI View Article : Google Scholar
10	Stephenson AJ, Shariat SF, Zelefsky MJ, Kattan MW, Butler EB, Teh BS, Klein EA, Kupelian PA, Roehrborn CG, Pistenmaa DA, et al: Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 291:1325–1332. 2004.PubMed/NCBI View Article : Google Scholar
11	Yossepowitch O, Briganti A, Eastham JA, Epstein J, Graefen M, Montironi R and Touijer K: Positive surgical margins after radical prostatectomy: A systematic review and contemporary update. Eur Urol. 65:303–313. 2014.PubMed/NCBI View Article : Google Scholar
12	Negishi T, Kuroiwa K, Hori Y, Tomoda T, Uchino H, Tokuda N, Furubayashi N, Nagase K, Iwai H and Nakamura M: Predictive factors of late biochemical recurrence after radical prostatectomy. Jpn J Clin Oncol. 47:233–238. 2017.PubMed/NCBI View Article : Google Scholar
13	Blute ML, Bostwick DG, Bergstralh EJ, Slezak JM, Martin SK, Amling CL and Zincke H: Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology. 50:733–739. 1997.PubMed/NCBI View Article : Google Scholar
14	Simon RM, Howard LE, Freedland SJ, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR and Vidal AC: Adverse pathology and undetectable ultrasensitive prostate-specific antigen after radical prostatectomy: Is adjuvant radiation warranted? BJU Int. 117:897–903. 2016.PubMed/NCBI View Article : Google Scholar
15	Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V and Lebret T: Positive surgical margins after radical prostatectomy: What should we care about? World J Urol. 33:1973–1978. 2015.PubMed/NCBI View Article : Google Scholar
16	Simon MA, Kim S and Soloway MS: Prostate specific antigen recurrence rates are low after radical retropubic prostatectomy and positive margins. J Urol. 175:140–145. 2006.PubMed/NCBI View Article : Google Scholar
17	Cao D, Kibel AS, Gao F, Tao Y and Humphrey PA: The Gleason score of tumor at the margin in radical prostatectomy is predictive of biochemical recurrence. Am J Surg Pathol. 34:994–1001. 2010.PubMed/NCBI View Article : Google Scholar
18	Humphrey PA: WHO clasification of tumors of the prostate, pp138-162, 2016.
19	Stephenson AJ, Wood DP, Kattan MW, Klein EA, Scardino PT, Eastham JA and Carver BS: Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. J Urol. 182:1357–1363. 2009.PubMed/NCBI View Article : Google Scholar
20	Wright JL, Dalkin BL, True LD, Ellis WJ, Stanford JL, Lange PH and Lin DW: Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol. 183:2213–2218. 2010.PubMed/NCBI View Article : Google Scholar
21	Preston MA, Carrière M, Raju G, Morash C, Doucette S, Gerridzen RG, Bella AJ, Eastham JA, Scardino PT and Cagiannos I: The prognostic significance of capsular incision into tumor during radical prostatectomy. Eur Urol. 59:613–618. 2011.PubMed/NCBI View Article : Google Scholar
22	Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD and Walsh PC: Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 281:1591–1597. 1999.PubMed/NCBI View Article : Google Scholar
23	Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL, Partin AW and Walsh PC: Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. 299:2760–2769. 2008.PubMed/NCBI View Article : Google Scholar
24	Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Störkel S, Willich N, Semjonow A, Souchon R, Stöckle M, et al: Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 27:2924–2930. 2009.PubMed/NCBI View Article : Google Scholar
25	Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L, de Reijke TM, Verbaeys A, Bosset JF, van Velthoven R, et al: Postoperative radiotherapy after radical prostatectomy: A randomised controlled trial (EORTC trial 22911). Lancet. 366:572–578. 2005.PubMed/NCBI View Article : Google Scholar
26	Van der Kwast TH, Bolla M, Van Poppel H, Van Cangh P, Vekemans K, Da Pozzo L, Bosset JF, Kurth KH, Schröder FH and Collette L: EORTC 22911. Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol. 25:4178–4186. 2007.PubMed/NCBI View Article : Google Scholar
27	Resnick MJ, Canter DJ, Guzzo TJ, Magerfleisch L, Tomaszewski JE, Brucker BM, Bergey MR, Sonnad SS, Wein AJ and Malkowicz SB: Defining pathological variables to predict biochemical failure in patients with positive surgical margins at radical prostatectomy: Implications for adjuvant radiotherapy. BJU Int. 105:1377–1380. 2010.PubMed/NCBI View Article : Google Scholar
28	Chapin BF, Nguyen JN, Achim MF, Navai N, Williams SB, Prokhorova IN, Wang X, Tapia EM, Davis JW and Troncoso P: Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer. Prostate Cancer Prostatic Dis. 21:221–227. 2018.PubMed/NCBI View Article : Google Scholar
29	Preisser F, Coxilha G, Heinze A, Oh S, Chun FK, Sauter G, Pompe RS, Huland H, Graefen M and Tilki D: Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer. Prostate. 79:1832–1836. 2019.PubMed/NCBI View Article : Google Scholar
30	Udo K, Cronin AM, Carlino LJ, Savage CJ, Maschino AC, Al-Ahmadie HA, Gopalan A, Tickoo SK, Scardino PT, Eastham JA, et al: Prognostic impact of subclassification of radical prostatectomy positive margins by linear extent and Gleason grade. J Urol. 189:1302–1307. 2013.PubMed/NCBI View Article : Google Scholar
31	Viers BR, Sukov WR, Gettman MT, Rangel LJ, Bergstralh EJ, Frank I, Tollefson MK, Thompson RH, Boorjian SA and Karnes RJ: Primary Gleason grade 4 at the positive margin is associated with metastasis and death among patients with Gleason 7 prostate cancer undergoing radical prostatectomy. Eur Urol. 66:1116–1124. 2014.PubMed/NCBI View Article : Google Scholar
32	Walz J, Joniau S, Chun FK, Isbarn H, Jeldres C, Yossepowitch O, Chao-Yu H, Klein EA, Scardino PT, Reuther A, et al: Pathological results and rates of treatment failure in high-risk prostate cancer patients after radical prostatectomy. BJU Int. 107:765–770. 2011.PubMed/NCBI View Article : Google Scholar
33	Marks RA, Koch MO, Lopez-Beltran A, Montironi R, Juliar BE and Cheng L: The relationship between the extent of surgical margin positivity and prostate specific antigen recurrence in radical prostatectomy specimens. Hum Pathol. 38:1207–1211. 2007.PubMed/NCBI View Article : Google Scholar
34	Cao D, Humphrey PA, Gao F, Tao Y and Kibel AS: Ability of linear length of positive margin in radical prostatectomy specimens to predict biochemical recurrence. Urology. 77:1409–1414. 2011.PubMed/NCBI View Article : Google Scholar
35	Kawai H: Grneral rule for clinical and pathological studies on prostate cancer: 70-71, 2010.