Influencing factors for positive surgical margin after radical laparoscopic resection for prostate can-cer

Abstract

Objective To investigate the predictive factors for positive surgical margin after laparoscopic radical prostatectomy. Methods A retrospective analysis was performed for the clinical data of 238 patients with prostate cancer who received laparoscopic radical prostatectomy in Department of Urinary Surgery, The Affiliated Hospital of Qingdao University from June 2018 to May 2022, and they were divided into negative margin group and positive margin group according to postoperative pathology. Related data of two groups were compared, including general clinical data (age, body mass index, prostate volume, and surgical procedure), preoperative serum total prostate-specific antigen (TPSA), related indices [TPSA, free prostate-specific antigen/TPSA ratio, and prostate-specific antigen density (PSAD)], puncture-related factors (percentage of positive biopsy cores and preoperative puncture Gleason score), and preoperative MRI radiological features (preoperative clinical stage, prostate imaging report and Prostate Imaging Reporting and Data System score, location of abnormal tumor signal on mpMRI, site of abnormal tumor signal on mpMRI, membranous urethra length on mpMRI, and maximum transverse diameter of abnormal tumor signal on mpMRI), and the influencing factors for positive margin after laparoscopic radical prostatectomy were analyzed. Results There were significant differences between the two groups in serum TPSA, serum PSAD, preoperative puncture Gleason score, preoperative percentage of positive biopsy cores, preoperative clinical stage, and location of abnormal signal on mpMRI (χ2=22.539-62.367,P<0.05). The multivariate analysis showed that preoperative clinical stage (OR=3.574,95%CI=1.975-9.298,P<0.05) and preo-perative percentage of positive biopsy cores (OR=5.043,95%CI=2.496-10.189,P<0.05) were independent influencing factors for positive margin. Conclusion Preoperative clinical stage and preoperative percentage of positive biopsy cores are independent influencing factors for positive margin after laparoscopic radical prostatectomy, and this study provides a reference for predicting positive margin based on mpMRI radiological features among clinicians.

Keywords

• prostatic neoplasms|prostatectomy|laparoscopy|magnetic resonance imaging|positive margins of excision|influencing factor