Yu Young Dong, Lee Minseung, Hong Sung Kyu, Byun Seok-Soo, Lee Sang Eun, Lee Sangchul
1 Department of Urology, Seoul National University Bundang Hospital , Seongnam, Korea.
2 Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam, Korea.
J Endourol. 2018 Jan;32(1):46-53. doi: 10.1089/end.2017.0693. Epub 2018 Jan 5.
To evaluate the effects of prostatic apex shape variations on positive apical margin (PAM) rate after radical prostatectomy (RP) by undertaking a comparative study of robot-assisted laparoscopic radical prostatectomy (RALP) vs open radical prostatectomy (ORP).
A total of 3324 cases of RP (1004 ORP and 2320 RALP) from January 2004 to March 2017 were retrospectively reviewed. All patients underwent preoperative MRI and the cohorts were stratified into four categories according to prostatic apical shape at the midsagittal plane. Between ORP and RALP groups, age, body mass index, preoperative prostate-specific antigen (PSA), biopsy and pathological Gleason score (GS), clinical and pathological stage, and prostatic apex shapes were compared. Logistic regression analyses were performed to evaluate significant predictors of PAM. Propensity adjustments were undertaken before statistical analysis to minimize the lack of randomization.
ORP and RALP groups showed no significant differences in age, body mass index, PSA, biopsy and pathological GS, clinical and pathological stage, as well as prostatic apical shape variations. The ORP group showed a PAM of 17.5% that was significantly higher than 12.3% of the RALP group (p < 0.001). Both groups showed the highest PAM with apical type 3, which is the apex covering the posterior aspect of membranous urethra (ORP 33.9%, RALP 28.5%). In unadjusted data, multiple logistic regression analysis showed that prostate apical type 3 was a significant independent predictor of PAM, but other apex types were not.
Prostate apical type 3 was a significant independent predictor of PAM. The RALP group showed better outcomes in terms of PAM compared with the ORP group. Preoperative MRI might be a potentially useful tool for preoperative designing of the surgical modalities.
通过对机器人辅助腹腔镜根治性前列腺切除术（RALP）与开放性根治性前列腺切除术（ORP）进行对比研究，评估前列腺尖部形态变异对根治性前列腺切除术后阳性切缘（PAM）发生率的影响。
回顾性分析2004年1月至2017年3月期间共3324例根治性前列腺切除术病例（1004例ORP和2320例RALP）。所有患者术前行MRI检查，并根据前列腺尖部在矢状面的形态将队列分为四类。比较ORP组和RALP组之间的年龄、体重指数、术前前列腺特异性抗原（PSA）、活检及病理Gleason评分（GS）、临床及病理分期以及前列腺尖部形态。进行逻辑回归分析以评估PAM的显著预测因素。在统计分析前进行倾向调整以尽量减少随机化的缺失。
ORP组和RALP组在年龄、体重指数、PSA、活检及病理GS、临床及病理分期以及前列腺尖部形态变异方面均无显著差异。ORP组的PAM发生率为17.5%，显著高于RALP组的12.3%（p < 0.001）。两组中3型尖部（覆盖膜部尿道后方的尖部）的PAM发生率最高（ORP为33.9%，RALP为28.5%）。在未调整的数据中，多因素逻辑回归分析显示前列腺3型尖部是PAM的显著独立预测因素，但其他尖部类型不是。
前列腺3型尖部是PAM的显著独立预测因素。与ORP组相比，RALP组在PAM方面显示出更好的结果。术前MRI可能是手术方式术前设计的潜在有用工具。
