Valor de los márgenes quirúrgicos de resección positivos en los pacientes con cáncer de próstata pT2: Implicaciones en el tratamiento adyuvante

objective: to analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer (pt2) in the prostatectomy specimen and its implications for adjuvant treatment. materials and method: retrospective study of 536 patients with stage pt2 prostate cancer, treated with radical prostatectomy between 1996 and 2007. subsequent to the prostatectomy, the following variables were collected: gleason score, pathological stage, capsular invasion, surgical margins and perineural invasion. we performed a univariate analysis and subsequently adjusted it by means of a cox proportional hazard model (enter method). results: 21.7% presented positive surgical margins and 20.9% developed biochemical recurrence after a mean follow-up of 57 months. 37.9% of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16% that did not have it (p<0.001). in the multivariate analysis, only the surgical margin (p<0.001) and the gleason score greater or equal to 8 (p<0.001) behaved as independent biochemical recurrence factors. on stratifying the series according to these two variables, we found that the patients with positive surgical margins and a gleason score of < 7 have a recurrence probability at 5 and 10years of 35% and 50% against 74% and 87% in the group with positive surgical margins and a gleason score of > 8 (p=0.002). conclusion: patients with pt2 prostate cancer, positive surgical margins and a gleason score of > 8 will benefit from adjuvant radiotherapy. 50% of the patients with positive margins and a gleason score of < 7 will not recur, which means that the indication of adjuvant radiotherapy continues to be controversial.