Predictors of Surgical Margin Status in Patients Following Radical Retropubic Prostatectomy: A Single-Centred, Single-Surgeon, Retrospective Study

• Ozgur Ekici ^[2] ; Murat Gunay ^[3] ; Abdullah Gul ^[1] ; Ozlem Admıs ^[3] ; Ali Seydi Bozkurt ^[4] ; Ercument Keskin ^[4]
  1. [1] Sakarya University

     Sakarya University

     Turquía

     
  2. [2] Department of Urology, Antalya Kepez Hospital, 07320 Antalya, Turkey
  3. [3] Department of Urology, Sakarya Sadıka Sabancı Hospital, 54580 Sakarya, Turkey
  4. [4] Department of Urology, Beyhekim Hospital, 54200 Sakarya, Turkey

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• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 77, Nº. 9, 2024, págs. 984-991
• Idioma: inglés
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• Resumen

  • Background: To determine the predictive value of patient’s preoperative characteristics and laboratory values for positive surgical margin (PSM) after radical retropubic prostatectomy (RRP).

    Methods: This study included 278 patients who underwent RRP between January 2011 and October 2022 due to prostate cancer (PCa) with no prior radiotherapy or hormonal treatment. The patients’ preoperative characteristics and laboratory findings were recorded, and the patients were divided into two groups based on their surgical margin status. Multivariate logistic regression was performed to assess the impact of the patients’ preoperative characteristics and laboratory results on PSM status.

    Results: The PSM group exhibited significantly higher body mass index (BMI), number of biopsy positive cores, percentage of tumours in positive cores, and neutrophil-to-lymphocyte ratio (NLR) than the negative surgical margin (NSM) group (p < 0.001, p = 0.004, p < 0.001, and p = 0.035, respectively). Conversely, the aspartate transaminase/alanine transaminase (AST/ALT) ratio was significantly lower in the PSM group than in the NSM group (p = 0.031). Compared to the NSM group, the PSM group had a significantly higher proportion of patients with a preoperative Gleason score (GS) of ≥8 and an elevated D’Amico risk (p < 0.001 and p = 0.046, respectively). Furthermore, BMI, preoperative prostate-specific antigen (PSA) level, percentage of tumours in positive cores, NLR, GS ≥8, and high D’Amico risk were significant independent predictors of PSM. The NLR cut-off value of ≥1.96 was found to be appropriate, leading to a sensitivity of 69%, specificity of 46%, positive predictive value of 13%, and negative predictive value of 93%. Lastly, the area under the receiver operating characteristic curve of the NLR for PSM was 0.581 (95% confidence interval: 0.52–0.64, p = 0.035).

    Conclusions: Our study results reveal that NLR, BMI, percentage of tumours in positive cores, preoperative PSA level, high-risk PCa, and GS ≥8 are predictive factors for PSM. Preoperative NLR may serve as an independent predictor of PSM following RRP.