Chen Shao-Hao, Ke Zhi-Bin, Wu Yu-Peng, Chen Dong-Ning, Yu Xiang, Chen Yu, Wei Yong, Zheng Qing-Shui, Xue Xue-Yi, Xu Ning
Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People's Republic of China.
Cancer Bio-Immunotherapy Center, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, People's Republic of China.
Cancer Manag Res. 2020 Sep 4;12:8005-8014. doi: 10.2147/CMAR.S265480. eCollection 2020.
To identify the relevant factors, and create and validate a predictive scoring system for the duration of laparoscopic radical prostatectomy (LRP).
We retrospectively analyzed clinicopathological data from 436 patients who underwent LRP between January 2014 and January 2019, of whom 304 cases were used as a model creation group and 132 were used as a validation group. Uni/multivariate linear regression analysis was performed to determine the predictors of the duration of the procedure and a novel scoring system was created using these predictors. External validation of the scoring system was performed. The Hosmer-Lemeshow test was used to determine the goodness-of-fit of the model and calibration plots were created for visual assessment.
"Prolonged duration" was defined as a duration of the procedure that was longer than the mean (>150 min) duration. Multivariate analysis showed that body mass index (BMI), prostate volume, intravesicular protrusion of the prostate (IPP), the ratio of the cross-sectional areas of the prostate and the Retzius space (P/R), pelvic lymph node dissection, and neurovascular bundle (NVB) preservation were significant predictors of prolonged duration. A scoring system that included these six parameters was created and the area under the curve achieved during receiver operating characteristic analysis using this scoring system was 0.874 (95% confidence interval [CI]: 0.836-0.913). The Hosmer-Lemeshow test showed that the scoring system was well calibrated (X=5.339, =0.376). The external validation showed that the model had high predictive accuracy (AUC=0.835, 95% CI: 0.764-0.906) and goodness-of-fit (X=4.401, =0.493).
The following factors were significantly associated with prolonged duration of laparoscopic radical prostatectomy: BMI, prostate volume, IPP, P/R, pelvic lymph node dissection, and NVB preservation. The novel scoring system created can be used to accurately predict the duration of the procedure, assess the difficulty of surgery, and improve perioperative efficiency.
确定相关因素，创建并验证腹腔镜根治性前列腺切除术（LRP）手术时长的预测评分系统。
我们回顾性分析了2014年1月至2019年1月期间接受LRP的436例患者的临床病理数据，其中304例作为模型创建组，132例作为验证组。进行单因素/多因素线性回归分析以确定手术时长的预测因素，并使用这些预测因素创建了一个新的评分系统。对该评分系统进行了外部验证。采用Hosmer-Lemeshow检验确定模型的拟合优度，并绘制校准图进行直观评估。
“手术时间延长”定义为手术时长超过平均时长（>150分钟）。多因素分析显示，体重指数（BMI）、前列腺体积、前列腺膀胱内突出（IPP）、前列腺与Retzius间隙横截面积之比（P/R）、盆腔淋巴结清扫以及神经血管束（NVB）保留是手术时间延长的显著预测因素。创建了一个包含这六个参数的评分系统，使用该评分系统在受试者工作特征分析中获得的曲线下面积为0.874（95%置信区间[CI]：0.836 - 0.913）。Hosmer-Lemeshow检验表明该评分系统校准良好（X = 5.339，P = 0.376）。外部验证显示该模型具有较高的预测准确性（AUC = 0.835，95% CI：0.764 - 0.906）和拟合优度（X = 4.401，P = 0.493）。
以下因素与腹腔镜根治性前列腺切除术手术时间延长显著相关：BMI、前列腺体积、IPP、P/R、盆腔淋巴结清扫以及NVB保留。创建的新评分系统可用于准确预测手术时长、评估手术难度并提高围手术期效率。
