Does index tumor predominant location influence prognostic factors in radical prostatectomies?

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Vol. 43 (x): 2017 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0335


ORIGINAL ARTICLE

Athanase Billis 1, Leandro L. L. Freitas 1, Larissa B. E. Costa 1, Camila M. de Angelis 1, Kelson R. Carvalho 1, Luis A. Magna 2, Ubirajara Ferreira 3
1 Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 2 Departamento de Genética Médica/Bioestatística, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 3 Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

ABSTRACT

Purpose: To find any influence on prognostic factors of index tumor according to predominant location.

Materials and Methods: Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was sub­divided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evalu­ated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (antero­lateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model.

Results: Index tumors with predominant posterior location were significantly associ­ated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic exten­sion, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analy­sis but not on multivariate analysis.

Conclusions: The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not of­fer advantage over other well-established prognostic factors.

Keywords: Neoplasms; Prostate; Prostatectomy; Prostate-Specific Antigen

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