Moureaux C, Boucaud-Maitre D, Brureau L, Gourtaud G, Senechal C, Roux V, Blanchet P, Eyraud R
Service d'urologie du CHU de Guadeloupe, route de Chauvel, 97159 Pointe à Pitre/Abymes, France.
Direction de la recherche clinique et de l'innovation (DRCI), CHU de Pointe-à-Pitre-Ricou, 97159 Pointe à Pitre/Abymes, France.
Prog Urol. 2018 Dec;28(16):906-914. doi: 10.1016/j.purol.2018.08.003. Epub 2018 Sep 13.
Anthropometric data report that pelvic bone of African subjects are narrower and the pelvic cavity is deeper. The aim of the study was to evaluate the influence of pelvic dimensions (PD) on Positive surgical margins (PSM) rate in Afro-Caribbean population after robot-assisted laparoscopic prostatectomy (RALP).
Preoperative pelvic MRI of all patients who have had RALP at the University Hospital Center of Guadeloupe between January 2013 and December 2015 was retrospectively analyzed. PD, including the Height of the upper edge of the prostate (HP), the Apical Depth (AD) and Ischial Spines Distance (ISD), and indexes (prostate volumetric index [ISD/VP], apical depth index [ISD/AD] and prostate depth index [ISD/(AD/HP)]) were compared according to the presence or absence of PSM with uni and multivariate analysis.
One hundred and seventy-eight patients were included in the study, of whom 60 (33.7%) presented PSM. In univariate analysis, significant differences between the presence or absence of PSM were observed on the AD (30.3±8.7mm versus 24.8±8.0mm, P<0.001), the HP (9.5±8.5mm versus 16.8±11.9mm, P<0.001) and the ISD (89.6±8.8mm versus 96.1±8.4mm) as well as the indexes of apical depth and prostatic depth. In multivariate logistic regression, the ISD (P<0.001) and HP (P=0.02) were associated with increased likelihood of PSM, but not AD or indexes.
This study suggests that interspinous distance is the best predictor of PSM during RALP in Afro-Caribbean patients. This measure may be useful to define the therapeutic pattern of patients with prostate cancer. A prospective study with a larger population, comparing RALP in Afro-Caribbean and in caucasians patients, would be needed.
人体测量数据表明，非洲受试者的骨盆骨更窄，盆腔更深。本研究的目的是评估骨盆尺寸（PD）对非洲加勒比人群机器人辅助腹腔镜前列腺切除术（RALP）后切缘阳性（PSM）率的影响。
回顾性分析2013年1月至2015年12月在瓜德罗普大学医院中心接受RALP治疗的所有患者的术前盆腔MRI。根据是否存在PSM，通过单因素和多因素分析比较PD，包括前列腺上缘高度（HP）、尖部深度（AD）和坐骨棘间距（ISD），以及各项指标（前列腺体积指数[ISD/VP]、尖部深度指数[ISD/AD]和前列腺深度指数[ISD/(AD/HP)]）。
178例患者纳入研究，其中60例（33.7%）出现PSM。单因素分析显示，PSM存在与否在AD（30.3±8.7mm对24.8±8.0mm，P<0.001）、HP（9.5±8.5mm对16.8±11.9mm，P<0.001）、ISD（89.6±8.8mm对96.1±8.4mm）以及尖部深度和前列腺深度指标方面存在显著差异。多因素逻辑回归分析显示，ISD（P<0.001）和HP（P=0.02）与PSM可能性增加相关，而AD或各项指标则不然。
本研究表明，在非洲加勒比患者的RALP手术中，棘间距离是PSM的最佳预测指标。该测量方法可能有助于确定前列腺癌患者的治疗模式。需要开展一项更大规模的前瞻性研究，比较非洲加勒比患者和白种人患者的RALP手术情况。
