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image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao British Journal of U...arrow_drop_down
image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao
British Journal of Urology
Article . 2021 . Peer-reviewed
License: Wiley Online Library User Agreement
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Clinical utility of subclassifying positive surgical margins at radical prostatectomy

Authors: Shawn Dason; Emily A. Vertosick; Kazuma Udo; Daniel D. Sjoberg; Andrew J. Vickers; Hikmat Al‐Ahmadie; Ying‐Bei Chen; +7 Authors

Clinical utility of subclassifying positive surgical margins at radical prostatectomy

Abstract

Objective To determine whether subclassification of positive surgical margins (PSMs) increases predictive ability for biochemical recurrence (BCR) and aids clinical decision‐making in patients undergoing radical prostatectomy. Patients and Methods We studied 2147 patients with pT2 and pT3a prostate cancer with detailed surgical margin parameters and BCR status. We compared a base model, a linear predictor calculated from the Memorial Sloan Kettering Cancer Center postoperative nomogram (prostate‐specific antigen, pathological tumour grade and stage), with the addition of surgical margin status to five additional models (base model plus surgical margin subclassifications) to evaluate enhancement in predictive accuracy. Decision curve analysis (DCA) was performed to determine the clinical utility of parameters that enhanced predictive accuracy. Results Among 2147 men, 205 had PSMs, and 231 developed BCR. Discrimination for the base model with addition of surgical margin status was high (c‐index = 0.801) and not meaningfully improved by adding surgical margin subclassification in the full cohort. In analyses considering only men with PSMs ( N = 55 with BCR), adding surgical margin subclassification to the base model increased discrimination for total length of all PSMs – alone or with maximum Gleason grade at the margin (c‐index improvement = 0.717 to 0.752 and 0.753, respectively). DCA demonstrated a modest benefit to clinical utility with the addition of these parameters. Conclusions Specific subclassification parameters add predictive accuracy for BCR and may aid clinical utility in decision‐making for patients with PSMs. These findings may be useful for patient counselling and future adjuvant therapy trial design.

Keywords

Male, Prostatectomy, Prostate, Humans, Margins of Excision, Prostatic Neoplasms, Neoplasm Grading, Neoplasm Recurrence, Local, Prostate-Specific Antigen

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
8
Top 10%
Average
Top 10%
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