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Long-Term (10-Year) Trends in the Rates of Positive Surgical Margins Among Patients With Prostate Cancer
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Positive surgical margins at the time of radical prostatectomy are associated with disease recurrence and the need for additional treatment. This study used data from the Victorian Prostate Cancer Outcomes Registry to investigate the rates of detection of positive surgical margins over time. The study identified 12,394 patients undergoing prostatectomy, with 3141 patients (25%) having positive surgical margins. After evaluating data regarding positive surgical margin rates over the past 10 years, the authors noted a decrease in the rates of detection of positive surgical margins from 50% in 2011 to 38% in 2020. The use of robotic surgical approaches was associated with lower margin positivity.
- These findings suggest that the rates of detection of positive surgical margins have been declining over the past 10 years and that this decline may be associated with improved robotic surgery methods.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersCONTEXT
Positive surgical margin (PSM) on radical prostatectomy (RP) is associated with an increased risk of biochemical recurrence and use of salvage therapies. Given these adverse consequences, exploration of time trends and predictors of PSM will improve the patient outcomes following surgery for prostate cancer.
METHODS
Pathological data from RP patients treated from 2011 to 2020 was extracted from the Victorian Prostate Cancer Outcomes Registry. This is a clinical quality registry that regularly benchmarks and reports back to individual clinicians the PSM percentage for their patients. Trends in PSM over time were visualized with separate running mean plots for both pT2 and pT3/4 disease. Predictors of PSM were explored with multivariable regression with date of surgery, surgical method, and hospital type, public or private, entered as covariates.
RESULTS
In total, 12,394 patients formed the sample with PSM recorded in 25% (n = 3,141) of patients, 12% (777/6,640) in pT2 disease and 41% (2,364/5,754) in pT3/4 disease. Comparing 2011-12 to 2019-20, the pT3/4 PSM proportion declined from 50% to 38% while pT2 percentages were steady at 13%. In "high volume" institutions, pT2 PSM fell from 12% to 6.5%. Independent predictors of lower PSM were robotic vs. open method and being treated at a private vs. public institution.
CONCLUSION
A clear decline in the proportion of pT3 PSM was observed in a large prostate cancer registry. Proposed explanatory factors include improved technical proficiency with robotic surgery and participation in a registry-based quality improvement initiative.
Additional Info
Disclosure statements are available on the authors' profiles:
A decade of declining prostatectomy margin positivity within a prostate cancer clinical quality registry
Urol. Oncol 2022 Sep 25;[EPub Ahead of Print], N Papa, M Perera, JG Bensley, M Evans, J Millar, M Frydenberg, DG Murphy, D BoltonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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