Porcaro Antonio Benito, Tafuri Alessandro, Sebben Marco, Amigoni Nelia, Shakir Aliasger, Corsi Paolo, Processali Tania, Pirozzi Marco, Rizzetto Riccardo, Bernasconi Riccardo, Cerrato Clara, Tiso Leone, Migliorini Filippo, Novella Giovanni, Brunelli Matteo, De Marco Vincenzo, Siracusano Salvatore, Artibani Walter
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126, Verona, Italy.
USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA.
J Robot Surg. 2020 Aug;14(4):663-675. doi: 10.1007/s11701-019-01039-5. Epub 2020 Jan 1.
The objective of this study is to evaluate if surgeon volume and stratifying positive surgical margins (PSM) into focal and non-focal may differentially impact the risk of biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Between January 2013 and December 2017, 732 consecutive patients were evaluated. The population included negative cases (control group) and PSM subjects (study group). PSMs were stratified as focal (≤ 1 mm) or non-focal (> 1 mm). A logistic regression model assessed the independent association of factors with the risk of PSM. The risk of BCR of PSM and other factors was assessed by Cox's multivariate proportional hazards. Overall, 192 (26.3%) patients had PSM focal in 133 patients; non-focal in 59 cases. Focal PSM was associated with the percentage of biopsy positive cores (BPC; OR 1.011; p = 0.015), extra-capsular extension (pT3a stage; OR 2.064; p = 0.016), seminal vesicle invasion (pT3b; OR 2.150; p = 0.010), body mass index (odds ratio, OR 0.914; p = 0.006), and high surgeon volume (OR 0.574; p = 0.006). BPC (OR 1.013; p = 0.044), pT3a (OR 4.832; p < 0.0001) and pT3b stage (OR 5.153; p = 0.001) were independent predictors of the risk of non-focal PSM. Surgeon volume was not a predictor of non-focal PSM (p = 0.224). Independent factors associated with the risk of BCR were baseline PSA (hazard ratio, HR 1.064; p = 0.004), BPC (HR 1.015; p = 0.027), ISUP biopsy grade group (BGG) 2/3 (HR 2.966; p 0.003) and BGG 4/5 (HR 3.122; p = 0.022) pathologic grade group 4/5 (HR 3.257; p = 0.001), pT3b (HR 2.900; p = 0.003), and non-focal PSM (HR 2.287; p = 0.012). Surgeon volume was not a predictor of BCR (p = 0.253). High surgeon volume is an independent factor that lowers the risk of focal PSM. Surgeon volume does not affect non-focal PSM and BCR. Negative as well as focal PSM are not associated with BCR.
本研究的目的是评估外科医生手术量以及将阳性手术切缘（PSM）分为局灶性和非局灶性是否会对机器人辅助根治性前列腺切除术（RARP）后生化复发（BCR）的风险产生不同影响。在2013年1月至2017年12月期间，对732例连续患者进行了评估。研究人群包括阴性病例（对照组）和PSM患者（研究组）。PSM被分为局灶性（≤1mm）或非局灶性（>1mm）。采用逻辑回归模型评估各因素与PSM风险的独立关联。通过Cox多变量比例风险模型评估PSM和其他因素的BCR风险。总体而言，192例（26.3%）患者有PSM，其中133例为局灶性；59例为非局灶性。局灶性PSM与活检阳性核心比例（BPC；OR 1.011；p = 0.015）、包膜外侵犯（pT3a期；OR 2.064；p = 0.016）、精囊侵犯（pT3b；OR 2.150；p = 0.010）、体重指数（比值比，OR 0.914；p = 0.006）以及高手术量的外科医生（OR 0.574；p = 0.006）相关。BPC（OR 1.013；p = 0.044）、pT3a（OR 4.832；p < 0.0001）和pT3b期（OR 5.153；p = 0.001）是非局灶性PSM风险的独立预测因素。外科医生手术量不是非局灶性PSM的预测因素（p = 0.224）。与BCR风险相关的独立因素包括基线前列腺特异性抗原（PSA）（风险比，HR 1.064；p = 0.004）、BPC（HR 1.015；p = 0.027）、国际泌尿病理学会（ISUP）活检分级组（BGG）2/3（HR 2.966；p 0.003）和BGG 4/5（HR 3.122；p = 0.022）、病理分级组4/5（HR 3.257；p = 0.001）、pT3b（HR 2.900；p = 0.003）以及非局灶性PSM（HR 2.287；p = 0.012）。外科医生手术量不是BCR的预测因素（p = 0.253）。高手术量的外科医生是降低局灶性PSM风险的独立因素。外科医生手术量不影响非局灶性PSM和BCR。阴性以及局灶性PSM与BCR无关。
