The impact of positive surgical margins on salvage radiation or androgen deprivation therapy following radical prostatectomy – a nationwide study

The extent to which positive surgical margins (PSM) affect the risk of subsequent salvage radiation therapy (sRT) or androgen depletion therapy (ADT) following radical prostatectomy (RP) is not well described. Initiation of additional therapies after RP depend on patient preference, individual factors, local guidelines, and life expectancy. The aim of this study was to analyze differences between margin status in risk of subsequent treatment for PCa following RP in a retrospective population-based cohort from Denmark. Patients who underwent RP were identified in The Danish Prostate Cancer Registry (DaPCaR). Subsequent sRT and ADT were assessed in uni- and multivariate settings and validated with receiver operating characteristic (ROC). PSM was associated with an increased risk of sRT (HR = 1.85, <i>p</i> p = .007). Margin status only had a minor impact on the predictive ability for sRT (area under the curve (AUC): <i>p</i> p = 1). Significant inter-institutional difference in the association between PSM with sRT or ADT was observed. PSM is associated with the risk of sRT and initiation of ADT, however this association is weak. Our results underline that factors beyond tumor characteristics play a major role for initiation of sRT and ADT.

手术切缘阳性（positive surgical margins, PSM）对根治性前列腺切除术（radical prostatectomy, RP）后后续挽救性放射治疗（salvage radiation therapy, sRT）或雄激素剥夺治疗（androgen depletion therapy, ADT）风险的影响程度，目前尚未得到充分阐述。根治性前列腺切除术后追加治疗的启动，取决于患者偏好、个体因素、当地诊疗指南以及预期寿命。本研究旨在基于丹麦的回顾性人群队列，分析前列腺癌（prostate cancer, PCa）患者行根治性前列腺切除术后，手术切缘状态与后续治疗风险之间的差异。研究对象为丹麦前列腺癌注册库（Danish Prostate Cancer Registry, DaPCaR）中收录的接受根治性前列腺切除术的患者。采用单因素与多因素分析模型评估后续挽救性放射治疗与雄激素剥夺治疗的发生情况，并通过受试者工作特征曲线（receiver operating characteristic, ROC）进行验证。手术切缘阳性与挽救性放射治疗风险升高相关（风险比HR=1.85，p=0.007）。手术切缘状态对挽救性放射治疗预测能力的影响较小（曲线下面积（area under the curve, AUC）：p=1）。研究观察到，手术切缘阳性与挽救性放射治疗或雄激素剥夺治疗之间的关联存在显著的机构间差异。手术切缘阳性与挽救性放射治疗及雄激素剥夺治疗的启动风险相关，但该关联较弱。本研究结果表明，除肿瘤特征外的其他因素，对挽救性放射治疗与雄激素剥夺治疗的启动具有重要影响。