Department of Urology, Larkin University Hospital, South Miami, Florida, USA.
Department of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA.
J Endourol. 2020 Apr;34(4):441-449. doi: 10.1089/end.2019.0714. Epub 2020 Mar 10.
Specimen pathology findings collectively impact the long-term outcomes of robot-assisted laparoscopic prostatectomy. Since seminal vesicle invasion (SVI) is an important independent predictor of biochemical recurrence (BCR), this study was designed to evaluate the influence of isolated SVI in the absence of capsular/margin invasion on BCR. Pathology reports of 2009 robot-assisted laparoscopic prostatectomy specimens were analyzed retrospectively excluding capsular breach and/or margin-positive cases to include 1409 patients in the study. Factors predicting SVI and BCR in this select group of patients were assessed and statistically analyzed. Survival analysis for PSA (prostate-specific antigen) failure probability and binomial regressions for variable predictability were performed. The African American race was associated with SVI ( < 0.05). PSA had a directly proportional correlation with the occurrence of SVI and BCR. SVI was found to be an independent predictor of BCR, leading to higher odds of BCR at 5 years (odds ratio [OR] 8.2, 95% confidence interval [CI] 4.5-14.6, < 0.0001). When the seminal vesicle was invaded, the specimen Gleason grade group (SGGG; OR 1.9, 95% CI 1.02-3.7, = 0.04), PSA (OR 1.2, 95% CI 1.01-1.4, = 0.03), and BMI (body mass index) (OR 1.2, 95% CI 1.04-1.5, = 0.01) predicted BCR. Seminal vesicle involvement was not found in SGGG 1. Risk stratification of significant predictors of BCR with isolated SVI identified a subgroup with BMI ≤27.9 kg/m, PSA ≤8.6 ng/mL, and SGGG 2, which had a significantly better prognosis ( = 0.029, log-rank test). Seminal vesicles are infrequently involved with SGGG 1. Select groups of patients with isolated SVI who have low-grade disease with relatively lower PSA and BMI do not have an aggressive biological behavior and are unlikely to have a BCR, thereby circumventing unnecessary adjuvant therapy with its attendant side effects. The BMI significantly predicted PSA failures and should be considered as an additional risk assessment tool.
标本病理学发现共同影响机器人辅助腹腔镜前列腺切除术的长期结果。由于精囊侵犯（SVI）是生化复发（BCR）的重要独立预测因子，因此本研究旨在评估在没有包膜/切缘侵犯的情况下孤立的 SVI 对 BCR 的影响。回顾性分析了 2009 年机器人辅助腹腔镜前列腺切除术标本的病理学报告，排除了包膜破裂和/或切缘阳性的病例，将 1409 例患者纳入研究。评估了该组患者中预测 SVI 和 BCR 的因素，并进行了统计学分析。对 PSA（前列腺特异性抗原）失败概率进行生存分析，并对变量预测能力进行二项式回归分析。非裔美国人种族与 SVI 相关（<0.05）。PSA 与 SVI 和 BCR 的发生呈直接比例相关。SVI 被发现是 BCR 的独立预测因子，导致 5 年时 BCR 的几率更高（优势比[OR]8.2，95%置信区间[CI]4.5-14.6，<0.0001）。当精囊被侵犯时，标本 Gleason 分级组（SGGG；OR 1.9，95%CI 1.02-3.7，=0.04）、PSA（OR 1.2，95%CI 1.01-1.4，=0.03）和 BMI（体质量指数）（OR 1.2，95%CI 1.04-1.5，=0.01）预测 BCR。在 SGGG 1 中未发现精囊受累。具有孤立 SVI 的 BCR 显著预测因子的风险分层确定了一个亚组，其 BMI≤27.9kg/m，PSA≤8.6ng/ml，且 SGGG 2，具有明显更好的预后（=0.029，对数秩检验）。SGGG 1 中精囊很少受累。具有孤立 SVI 的低级别疾病且 PSA 和 BMI 相对较低的特定患者群体没有侵袭性生物学行为，不太可能发生 BCR，从而避免了不必要的辅助治疗及其伴随的副作用。BMI 显著预测 PSA 失败，应被视为额外的风险评估工具。
