The prognostic significance of capsular incision into XXXX during radical prostatectomy.

@entity1 @entity263 @entity66 @entity5 @entity4207
BACKGROUND: The prognostic significance of capsular incision (CapI) into @entity5 during radical prostatectomy (RP) with otherwise organ-confined disease remains uncertain. OBJECTIVE: To evaluate the impact of CapI into @entity5 on oncologic outcome. DESIGN, SETTING, AND @entity1 : A retrospective review of 8110 consecutive @entity1 with @entity263 treated at Ottawa Hospital and at Memorial Sloan-Kettering Cancer Center, both tertiary @entity4207 centers, between 1985 and 2008. INTERVENTION: All @entity1 underwent an open, laparoscopic or robotic RP. MEASUREMENTS: @entity1 were divided into four pathologic categories: group 1 (CapI group), positive surgical margins (PSMs) without extraprostatic extension (EPE); group 2, negative surgical margins (NSMs) without EPE; group 3, NSM with EPE; group 4, PSMs with EPE. Estimates of recurrence-free survival were generated with the Kaplan-Meier method. Recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/ml and rising. Cox proportional hazards regression was used to estimate the hazard ratio (HR) for recurrence controlling for pretreatment PSA, RP date, RP Gleason sum, seminal vesicle invasion, and lymph node involvement. Pathologic categories were defined in the model by including the variables EPE and surgical margins (SMs) as well as their interaction. RESULTS AND LIMITATIONS: Median follow-up was 37.3 mo. The 5-yr recurrence-free probability after RP for the CapI group was 77% (95% confidence interval [CI], 72-83). This was not only inferior to @entity1 with NSMs and no EPE (log rank p<0.0001) but also to those with NSMs and EPE (log rank p=0.0002). In multivariate analysis the interaction between EPE and SM was not significant (p=0.26). In the adjusted model excluding the interaction term, @entity1 with EPE had an increased risk for recurrence (HR: 1.80; 95% CI, 1.49-2.17; p<0.0001) as did those with positive margins (HR: 1.81; 95% CI, 1.51-2.15; p<0.0001). This was a retrospective study. CONCLUSIONS: CapI into @entity5 has a significant impact on @entity1 outcome following RP. @entity1 , who otherwise would have organ-confined disease, will now have a higher probability of recurrence than those with completely resected @entity66 .
