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Valor de los márgenes quirúrgicos de resección positivos en los pacientes con cáncer de próstata pT2. Implicaciones en el tratamiento adyuvante
Value of Positive Resection Margins in Patients with pT2 Prostate Cancer. Implications for Adjuvant Treatment
J.E. Rosas-Navaa,
Autor para correspondencia
rosas_nava_jes@hotmail.com

Autor para correspondencia.
, F. Herranz-Amob, E.V. Paños-Fagundob, E. Lledó-Garcíab, F. Verdú-Tartajob, C. Hernández-Fernándezb
a Servicio de Urología, Hospital General de México DF, México
b Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
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La tercera parte de estos pacientes presentar&#225;n durante el seguimiento una elevaci&#243;n del ant&#237;geno prost&#225;tico espec&#237;fico &#40;PSA&#41; sin manifestaciones cl&#237;nicas o radiol&#243;gicas de met&#225;stasis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Alrededor del 30&#37; de los pacientes a quienes se les realiza una PR se encuentra en la pieza quir&#250;rgica m&#225;rgenes positivos &#40;MQP&#41;&#44; lo cual constituye un factor de mal pron&#243;stico e incrementa la recurrencia bioqu&#237;mica a los 5 a&#241;os entre el 12 y 18&#37;&#44; as&#237; como la mortalidad espec&#237;fica<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las Gu&#237;as Cl&#237;nicas de la <span class="elsevierStyleItalic">European Association of Urology</span> &#40;EAU&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> y del <span class="elsevierStyleItalic">National Comprehensive Cancer Network</span> &#40;NCCN&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> recomiendan la radioterapia adyuvante en los pacientes con MQP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es analizar el impacto sobre la supervivencia libre de recidiva bioqu&#237;mica &#40;SLRB&#41; de la afectaci&#243;n tumoral de los m&#225;rgenes quir&#250;rgicos de resecci&#243;n en los pacientes con CaP en estadio localizado &#40;pT2&#41; en la pieza de prostatectom&#237;a&#44; y su implicaci&#243;n en el tratamiento adyuvante&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Entre los a&#241;os 1996 y 2007 hemos realizado una PR a 536 pacientes con CaP localizado &#40;pT2&#41;&#44; pN0-Nx y un seguimiento superior a tres meses&#46; En el mes de diciembre del a&#241;o 2009 se ha realizado la &#250;ltima actualizaci&#243;n en la base de datos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los pacientes fueron clasificados previamente a la cirug&#237;a seg&#250;n los grupos de riesgo de recidiva bioqu&#237;mica de D&#8217;Amico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Para el estadio patol&#243;gico se utiliz&#243; la clasificaci&#243;n TNM de la UICC del a&#241;o 2002&#46; En ning&#250;n paciente se realiz&#243; tratamiento neo o adyuvante&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El seguimiento postcirug&#237;a consisti&#243; en una determinaci&#243;n del PSA a los tres meses&#44; semestral hasta el quinto a&#241;o y anual a partir de entonces&#46; Consideramos como recidiva bioqu&#237;mica &#40;RB&#41; la persistencia o elevaci&#243;n del PSA despu&#233;s de la prostatectom&#237;a radical por encima de 0&#44;4 ng&#47;ml y en ascenso en la siguiente determinaci&#243;n&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Hemos realizado un an&#225;lisis descriptivo de las variables analizadas mediante los estad&#237;sticos habituales para las variables cuantitativas &#40;media&#44; desviaci&#243;n est&#225;ndar&#44; mediana&#44; etc&#46;&#41; y cualitativas &#40;frecuencias absolutas&#44; etc&#46;&#41;&#46; El test exacto de Fisher y la prueba de la Chi cuadrado se utilizaron para evaluar la asociaci&#243;n entre variables categ&#243;ricas&#46; El m&#233;todo de Kaplan-Meier se ha utilizado para evaluar la supervivencia y el test de long-rank para evaluar las diferencias entre los distintos grupos con sus intervalos de confianza al 95&#37;&#46; Se realiz&#243; un an&#225;lisis univariante y posteriormente se ajust&#243; mediante un modelo de riesgos proporcionales de Cox &#40;m&#233;todo <span class="elsevierStyleItalic">enter</span>&#41;&#46; La significaci&#243;n estad&#237;stica se consider&#243; cuando existi&#243; una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Todos los c&#225;lculos se han realizado con el programa estad&#237;stico SPSS versi&#243;n 15&#46;0 en castellano&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los 536 pacientes ten&#237;an una mediana de edad de 64 a&#241;os y de 7&#44;5 ng&#47;ml de PSA&#59; el resto de las variables cl&#237;nicas se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Despu&#233;s de la prostatectom&#237;a el 17&#44;7&#37; de los pacientes ten&#237;a un <span class="elsevierStyleItalic">score</span> de Gleason &#40;SG&#41; &#8805; 8 y el 21&#44;7&#37; present&#243; MQP&#46; El resto de las variables patol&#243;gicas obtenidas despu&#233;s de la PR se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El 49&#37; present&#243; una concordancia entre el SG de la biopsia y el de la prostatectom&#237;a&#44; el 47&#44;2&#37; fue infraestadiado &#40;52&#44;9&#37; para el SG de 6 y 29&#44;1&#37; para el SG de 7&#41; y el 8&#44;1&#37; de los SG de 7 fue supraestadiado&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">El seguimiento de la serie fue de 63&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35 &#40;8-168&#41; con una mediana de 57 meses&#46; Al final del seguimiento&#44; 112 &#40;20&#44;9&#37;&#41; pacientes hab&#237;an presentado una RB&#46; En 9 &#40;8&#37;&#41; pacientes el PSA posprostatectom&#237;a nunca fue inferior a 0&#44;4 ng&#47;ml &#40;persistencia bioqu&#237;mica - PB&#41; y en 103 &#40;92&#37;&#41; casos la elevaci&#243;n del PSA fue despu&#233;s de un periodo de tiempo variable con PSA menor a 0&#44;4 ng&#47;ml&#46; El 15&#44;1&#37; de los pacientes clasificados como de bajo riesgo&#44; el 19&#44;8&#37; categorizado de riesgo intermedio y el 45&#44;1&#37; de riesgo alto &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; presentaron RB&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Al final del estudio 523 &#40;97&#44;6&#37;&#41; pacientes estaban vivos&#58; 414 &#40;77&#44;2&#37;&#41; sin RB&#44; 109 &#40;20&#44;3&#37;&#41; con RB y 13 &#40;2&#44;4&#37;&#41; hab&#237;an fallecido&#46; Fueron exitus 3 &#40;0&#44;5&#37;&#41; pacientes por c&#225;ncer de pr&#243;stata y 10 &#40;1&#44;7&#37;&#41; pacientes por otras causas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El 59&#44;8&#37; de los pacientes con RB fueron tratados con radioterapia de rescate&#44; el 19&#44;7&#37; con manipulaci&#243;n hormonal y al 20&#44;5&#37; no se le aplic&#243; ning&#250;n tratamiento de rescate&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La mediana de SLRB actuarial global de la serie fue 123&#44;6 meses &#40;IC 95&#37;&#58; 116&#44;8&#59; 130&#44;4&#41;&#46; La SLRB a los 5 y 10 a&#241;os se estim&#243; en un 78&#44;1 y en un 62&#44;4&#37; respectivamente&#46; La supervivencia global a los 5 y 10 a&#241;os se estim&#243; en un 97&#44;7 y un 94&#44;2&#37; respectivamente y la supervivencia c&#225;ncer espec&#237;fica a los 5 y 10 a&#241;os se estim&#243; en un 99&#44;3 y un 97&#44;1&#37; respectivamente&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El 37&#44;9&#37; de los pacientes con afectaci&#243;n patol&#243;gica de los m&#225;rgenes quir&#250;rgicos de resecci&#243;n present&#243; RB frente al 16&#37; de los que no la ten&#237;an &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En el an&#225;lisis univariante se observ&#243; una relaci&#243;n con la RB de las siguientes variables patol&#243;gicas&#58; <span class="elsevierStyleItalic">score</span> de Gleason &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; afectaci&#243;n patol&#243;gica de los m&#225;rgenes quir&#250;rgicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; e invasi&#243;n capsular &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; El resto de los datos del an&#225;lisis univariante se detalla en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; En el an&#225;lisis multivariante se introdujeron las siguientes variables&#58; <span class="elsevierStyleItalic">score</span> de Gleason&#44; margen quir&#250;rgico de resecci&#243;n e invasi&#243;n capsular&#46; Solo el margen quir&#250;rgico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y el <span class="elsevierStyleItalic">score</span> de Gleason &#8805; 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se comportaron como factores independientes de recidiva bioqu&#237;mica &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Estratificamos seg&#250;n el estado de los m&#225;rgenes quir&#250;rgicos &#40;MQ&#41; y el SG de la prostatectom&#237;a en 4 grupos de riesgo&#58; 1&#41; MQ &#40;-&#41; y SG &#8804; 7&#59; 2&#41; MQ &#40;-&#41; y SG &#8805; 8&#59; 3&#41; MQ &#40;&#43;&#41; y SG &#8804; 7&#59; 4&#41; MQ &#40;&#43;&#41; y SG &#8805; 8&#46; El porcentaje de recidiva en estos grupos fue del 11&#44;7&#44; 37&#44;5&#44; 31 y 60&#44;7&#37; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La probabilidad de recidiva a los 5 y 10 a&#241;os en funci&#243;n de estos grupos de riesgo se detalla en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#46; Los pacientes con MQ &#40;&#43;&#41; y SG &#8804; 7 presentaron una probabilidad de recidiva a los 5 y 10 a&#241;os del 35 y del 50&#37;&#44; frente al 74 y 87&#37; en el grupo de MQ &#40;&#43;&#41; y SG &#8805; 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Actualmente la cirug&#237;a radical de pr&#243;stata ofrece un excelente control para la enfermedad localizada&#59; sin embargo&#44; en una tercera parte de las piezas quir&#250;rgicas se encuentran MQP&#44; invasi&#243;n de la ves&#237;cula seminal y&#47;o extensi&#243;n extracapsular&#44; con lo que aumenta el riesgo de recurrencia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En nuestro estudio encontramos un 21&#44;7&#37; de pacientes con MQP&#44; de los que solo el 37&#44;9&#37; presentaron RB&#44; siendo significativo&#44; ya que s&#243;lo el 16&#37; de los pacientes que no ten&#237;an MQP tuvieron RB&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La presencia de m&#225;rgenes positivos incrementa el riesgo de recurrencia bioqu&#237;mica y local despu&#233;s de la PR<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#59; adem&#225;s&#44; Stephenson et al encontraron que los pacientes con MQP&#44; SG de 8-10 y tiempo de duplicaci&#243;n del PSA de menos de 10 meses tienen mayor riesgo de desarrollar met&#225;stasis<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La recurrencia del c&#225;ncer de pr&#243;stata despu&#233;s de una cirug&#237;a potencialmente curativa contin&#250;a siendo un dilema&#44; ya que los pacientes sienten que han perdido la oportunidad inicial de curaci&#243;n&#44; manifestando la urgencia de iniciar otro tratamiento para lograr la curaci&#243;n&#46; Sin embargo&#44; para los m&#233;dicos es a&#250;n dif&#237;cil decidir cu&#225;l es el tratamiento m&#225;s conveniente a seguir&#44; ya sea iniciar un manejo adyuvante&#44; o esperar hasta la aparici&#243;n de elevaci&#243;n del PSA<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En los pacientes con MQP o pT3 la radioterapia inmediata despu&#233;s de la PR incrementa la supervivencia libre de progresi&#243;n bioqu&#237;mica&#44; el control local y el riesgo de progresi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Por otro lado&#44; recientemente se corrobor&#243; que los pacientes que reciben radioterapia adyuvante &#40;RTA&#41; muestran un incremento de un 10&#37; en la supervivencia general&#44; y un 8&#37; en la supervivencia libre de met&#225;stasis<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Katz et al comunicaron que los pacientes con MQP son los que tienen la menor probabilidad de control bioqu&#237;mico con la radioterapia de rescate<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La RTA generalmente es bien tolerada y las reacciones de toxicidad secundarias&#44; por lo general&#44; son de bajo grado<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a>&#46; Se ha observado que la calidad de vida es mayor en los pacientes que reciben RTA&#44; ya que despu&#233;s de dos a&#241;os los pacientes que no la recibieron inicialmente comienzan con diversas terapias de rescate que tienen mayores efectos adversos&#44; y con ello un mayor impacto en la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La RTA est&#225; indicada en los pacientes pT2 con MQP&#44; sin embargo debemos individualizar cada caso seg&#250;n sus factores de riesgo<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Leibovich et al observaron que los pacientes con pT2 y m&#225;rgenes positivos que eran manejados con RTA presentaban una tasa del 88&#37; sin RB&#44; comparados con los que se manten&#237;an s&#243;lo en vigilancia&#44; en quienes se encontr&#243; una tasa del 59&#37; sin RB &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El SG &#8805; 8 en los pacientes con CaP &#243;rgano confinado &#40;pT2&#41; y MQP aumenta de forma significativa la probabilidad de RB&#46; Estos pacientes ser&#237;an los que m&#225;s se beneficiar&#237;an de una RTA&#44; mientras que en el 50&#37; de los pacientes con MQP y SG &#8804; 7 la RTA se podr&#237;a considerar como un sobretratamiento&#59; adem&#225;s&#44; ser&#225; posible su rescate con radioterapia en el supuesto de que presenten una RB&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto sobre la supervivencia libre de recidiva bioqu&#237;mica de la afectaci&#243;n tumoral de los m&#225;rgenes quir&#250;rgicos de resecci&#243;n en los pacientes con c&#225;ncer de pr&#243;stata en estadio localizado &#40;pT2&#41; en la pieza de prostatectom&#237;a y su implicaci&#243;n en el tratamiento adyuvante&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de 536 pacientes con c&#225;ncer de pr&#243;stata en un estadio pT2 tratados con prostatectom&#237;a radical entre 1996 y 2007&#46; Posteriormente a la prostatectom&#237;a se recogieron las siguientes variables&#58; <span class="elsevierStyleItalic">score</span> de Gleason&#44; estadio patol&#243;gico&#44; invasi&#243;n capsular&#44; m&#225;rgenes quir&#250;rgicos e invasi&#243;n perineural&#46; Se realiz&#243; un an&#225;lisis univariante y posteriormente se ajust&#243; mediante un modelo de riesgos proporcionales de Cox &#40;m&#233;todo <span class="elsevierStyleItalic">enter</span>&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El 21&#44;7&#37; present&#243; m&#225;rgenes quir&#250;rgicos positivos y el 20&#44;9&#37; desarroll&#243; recidiva bioqu&#237;mica con una mediana de seguimiento de 57 meses&#46; El 37&#44;9&#37; de los pacientes con afectaci&#243;n patol&#243;gica de los m&#225;rgenes quir&#250;rgicos de resecci&#243;n present&#243; recidiva bioqu&#237;mica&#44; frente al 16&#37; de los que no la ten&#237;an &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis multivariante solo el margen quir&#250;rgico &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y el <span class="elsevierStyleItalic">score</span> de Gleason mayor o igual a 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se comportaron como factores independientes de recidiva bioqu&#237;mica&#46; Al estratificar la serie seg&#250;n estas dos variables encontramos que los pacientes con m&#225;rgenes quir&#250;rgicos positivos y <span class="elsevierStyleItalic">score</span> de Gleason &#8804; 7 tienen una probabilidad de recidiva a los 5 y 10 a&#241;os del 35 y del 50&#37;&#44; frente al 74 y 87&#37; en el grupo con m&#225;rgenes quir&#250;rgicos positivos y <span class="elsevierStyleItalic">score</span> de Gleason &#8805; 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con c&#225;ncer de pr&#243;stata pT2&#44; m&#225;rgenes quir&#250;rgicos positivos y <span class="elsevierStyleItalic">score</span> de Gleason &#8805; 8 se beneficiar&#225;n de una radioterapia adyuvante&#46; El 50&#37; de los pacientes con m&#225;rgenes positivos y un <span class="elsevierStyleItalic">score</span> de Gleason &#8804; 7 no presentar&#225;n recidiva&#44; por lo que la indicaci&#243;n de radioterapia adyuvante sigue siendo controvertida&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer &#40;pT2&#41; in the prostatectomy specimen and its implications for adjuvant treatment&#46;</p> <span class="elsevierStyleSectionTitle">Materials and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 536 patients with stage pT2 prostate cancer&#44; treated with radical prostatectomy between 1996 and 2007&#46; Subsequent to the prostatectomy&#44; the following variables were collected&#58; Gleason score&#44; pathological stage&#44; capsular invasion&#44; surgical margins and perineural invasion&#46; We performed a univariate analysis and subsequently adjusted it by means of a Cox proportional hazard model &#40;enter method&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">21&#46;7&#37; presented positive surgical margins and 20&#46;9&#37; developed biochemical recurrence after a mean follow-up of 57 months&#46; 37&#46;9&#37; of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16&#37; that did not have it &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In the multivariate analysis&#44; only the surgical margin &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and the Gleason score greater or equal to 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; behaved as independent biochemical recurrence factors&#46; On stratifying the series according to these two variables&#44; we found that the patients with positive surgical margins and a Gleason score of &#8804; 7 have a recurrence probability at 5 and 10<span class="elsevierStyleHsp" style=""></span>years of 35&#37; and 50&#37; against 74&#37; and 87&#37; in the group with positive surgical margins and a Gleason score of &#8805; 8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients with pT2 prostate cancer&#44; positive surgical margins and a Gleason score of &#8805; 8 will benefit from adjuvant radiotherapy&#46; 50&#37; of the patients with positive margins and a Gleason score of &#8804; 7 will not recur&#44; which means that the indication of adjuvant radiotherapy continues to be controversial&#46;</p>"
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                          "autores" => array:4 [
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