Positive surgical margins at radical prostatectomy in the United States: Institutional variations and predictive factors

Aydin Pooli; Amirali Salmasi; David C Johnson; Andrew T Lenis; Izak Faiena; Cedric Lebacle; Vishnukamal Golla; Alexandra Drakaki; Kiran Gollapudi; Jeremy Blumberg; Allan J Pantuck; Karim Chamie

doi:10.1016/j.urolonc.2019.08.016

Positive surgical margins at radical prostatectomy in the United States: Institutional variations and predictive factors

Urol Oncol. 2020 Jan;38(1):1.e17-1.e23. doi: 10.1016/j.urolonc.2019.08.016. Epub 2019 Sep 16.

Authors

Affiliations

¹ Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA. Electronic address: apooli@mednet.ucla.edu.
² Department of Urology, University of California, San Diego, CA.
³ Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Veterans Affairs/UCLA National Clinician Scholars Program, Los Angeles, CA.
⁴ Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA.
⁵ Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Urology, University Hospital Bicetre, APHP, University Paris-Saclay, Le Kremlin Bicetre, France.
⁶ Institute of Urologic Oncology (IUO) at UCLA, Department a of Urology, David Geffen School of Medicine, Los Angeles, CA; Department of Hematology and Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁷ Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.

PMID: 31537483
DOI: 10.1016/j.urolonc.2019.08.016

Abstract

Introduction: Positive surgical margins (PSMs) are associated with treatment failure after radical prostatectomy (RP) for patients with prostate cancer (CaP). We investigated institutional variations in PSM after RP, as well as clinical and demographic factors predicting PSM.

Patients and methods: Patients undergoing RP for clinically localized CaP were identified in the National Cancer Database in 2010 to 2013 and clinicodemographics were recorded. Treating institution was defined as academic (AMC) or nonacademic medical centers (nAMC). The primary outcome was the PSM rate. Multivariable logistic regression and propensity matching with inverse probability treatment weighing were used to both compare outcomes between AMC and nAMC and to identify predictors of PSM following RP.

Results: A total of 167,260 patients met our inclusion criteria. PSM rate was significantly lower in patients treated at AMC (13,435, 18.9%) compared with 22,145 (23.0%) in those treated at nAMC (P < 0.01). The difference between PSM rate in AMC and nAMC was more pronounced in lower volume centers while it was not significant in higher volume centers. On multivariable analysis, age, race, prostate-specific antigen (PSA), biopsy Gleason score, comorbidity profile, insurance type, income, and treatment facility were significantly associated with PSM rate.

Conclusion: PSM rates appear to be lower at AMC and higher volume facilities, which can potentially reflect institutional differences in surgical quality. In addition, we identified several socioeconomic and demographic factors that contribute to the likelihood of PSM following RP for localized CaP, suggesting potential systematic variation in the quality of surgical care. The cause of this variation warrants further investigation and evaluation.

Keywords: Positive surgical margins; Prostate cancer; Radical prostatectomy.

MeSH terms

Humans
Male
Margins of Excision*
Middle Aged
Prostatectomy / methods*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / surgery*
United States