Importance of Reporting Gleason Score at the Positive Surgical Margin Site Assessed

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Lower Gleason Score at the positive surgical margin site independently associated with shorter margin length and decreased risk of biochemical recurrence.
Lower Gleason Score at the positive surgical margin site independently associated with shorter margin length and decreased risk of biochemical recurrence.

A lower Gleason Score (GS) at the positive surgical margin (PM) site is independently associated with a shorter margin length and a decreased risk of early biochemical recurrence, according to a study published online ahead of print in The Journal of Urology.

Researchers evaluated how the GS and the length of the PM correlated with the grade and adverse pathologic characteristics of the final specimen, and whether the PM GS was linked to the risk of early biochemical recurrence (BCR).

A total of 4,082 patients undergoing radical prostatectomy and pelvic lymph node dissection between 2010 and 2014 for localized prostate cancer were included in the study. Of this population, 405 patients had a GS ≥7 of the primary nodule and a PM with the length and GS recorded at the margin.

The study's findings identified BCR in 22% of patients with positive margins (versus 5.6% without positive margins), metastases in 3% (versus 0.5%), and adjuvant radiation in 30% (versus 4.1%). Mean follow-up time was 22 months.

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The GS at the PM was the same as the final pathology specimen in 44% of patients, and a lower GS in 56% of patients. A shorter PM was independently associated with a lower GS at the margin (P=0.02). In multivariate Cox models, having a lower grade margin was associated with decreased risk of BCR (HR, 0.50; OR, 0.25-0.97).

Reference

  1. Kates M, Sopko NA, Han M, et al. Importance of reporting The Gleason Score at the positive surgical margin site: an analysis of 4,082 consecutive radical prostatectomy cases. J Urol. 2015. [epub ahead of print]. doi: 10.1016/juro.2015.08.002.

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