A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy
Articolo
Data di Pubblicazione:
2018
Citazione:
A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy / V.R. Patel, M. Sandri, A.A.C. Grasso, E. De Lorenzis, F. Palmisano, G. Albo, R.F. Coelho, A. Mottrie, T. Harvey, D. Kameh, H. Palayapalayam, P. Wiklund, S. Bosari, S. Puliatti, P. Zuccolotto, G. Bianchi, B. Rocco. - In: BJU INTERNATIONAL. - ISSN 1464-4096. - 121:3(2018 Mar), pp. 373-382. [10.1111/bju.14026]
Abstract:
Objectives
To create a statistical tool for the estimation of extracapsular
extension (ECE) level of prostate cancer and determine the
nerve-sparing (NS) approach that can be safely performed
during radical prostatectomy (RP).
Patients and Methods
A total of 11 794 lobes, from 6 360 patients who underwent rob ot-
assisted RP between 2008 and 2016 we re evaluated.
Clin icopatholog ical features we re included in a statistical
algorithm for the prediction of the maximum ECE width. Five
multivariable logistic models were estimated for: presence of ECE
and ECE width of >1, >2, >3, and >4mm.Afive-zone decision
rule bas ed on a lower and upper threshold is proposed. Using a
graphical interface, surgeons can view patient’spre-treatment
characteristics and a curve showing the estim ated probabilities for
ECE amount together with the areas identified by the decision rule.
Results
Of the 6 360 patients, 1 803 (28.4%) were affected by
non-organ-confined disease. ECE was present in 1 351 lobes
(11.4%) and extended beyond the capsule for >1, >2, >3, and
>4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%)
cases, respectively. ECE width was up to 15 mm (interquartile
range 1.00–2.00). The five logistic models showed good
predictive performance, the area under the receiver operating
characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88,
and 0.90 for ECE width of >1, >2, >3, and >4 mm,
respectively.
Conclusion
This novel tool predicts w ith good accuracy the presence and
amount of ECE. Furthermore, the graphical interface available
at www.prece.it can support surgeons in patient counselling
and preoperative planning.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
extracapsular extension; nomogram; prostate; prostate cancer; robotic prostatectomy; staging
Elenco autori:
V.R. Patel, M. Sandri, A.A.C. Grasso, E. DE LORENZIS, F. Palmisano, G. Albo, R.F. Coelho, A. Mottrie, T. Harvey, D. Kameh, H. Palayapalayam, P. Wiklund, S. Bosari, S. Puliatti, P. Zuccolotto, G. Bianchi, B. Rocco
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