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BJU Int. 2018 Mar;121(3):373-382. doi: 10.1111/bju.14026. Epub 2017 Oct 22.

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy.

Author information

1
Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA.
2
Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy.
3
Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy.
4
Department of Urology, Instituto do Cancer, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil.
5
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
6
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
7
Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
8
Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Policlinico, University of Milan, Milan, Italy.
9
Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy.
10
Big & Open Data Innovation Laboratory, University of Brescia, Brescia, Italy.

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 robot-assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were 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 >4 mm. A five-zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre-treatment characteristics and a curve showing the estimated 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 with 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.

KEYWORDS:

extracapsular extension; nomogram; prostate; prostate cancer; robotic prostatectomy; staging

PMID:
28941058
DOI:
10.1111/bju.14026
[Indexed for MEDLINE]

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