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Robot assisted radical prostatectomy in fit older patients compared to a standard population: Clinical characteristics, surgical, oncological and functional outcomes. Prog Urol 2023; 33:272-278. [PMID: 36764858 DOI: 10.1016/j.purol.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION To compare robotic assisted radical prostatectomy (RARP) in well-selected older patients with clinically localized prostate cancer, compared to a younger population. Primary endpoint was perioperative outcomes comparison and secondary endpoint were oncological and functional outcomes comparison to a younger population. METHODS Single tertiary center cohort of consecutive patients treated with RARP (2017-2020) with retrospective analysis. Patients were classified by age in two groups: <75: control group (CG) and ≥75: study group (SG). Patients aged ≥75 had a comprehensive geriatric assessment (CGA) and only patients classified Balducci ≤2 were admitted to surgery. RESULTS Two hundred and sixty-nine patients were included, 56 in SG and 213 in CG. Median follow-up was 9.8 months. Univariate analysis showed no statistically significant (SS) difference between the groups for patients' characteristics (PSA, digital rectal examination -DRE- and biopsy Gleason Score), perioperative data (operative time, hospitalization length, transfusions rate, immediate complications, Clavien-Dindo complications, 30-days re-interventions and 30-days re-hospitalisation), oncological (TNM, margins, extraprostatic extension, postoperative PSA, BCR, metastases, overall survival -OS- and cancer specific survival -CSS-) and functional outcomes. Median perioperative blood loss was lower in the SG: 200.00 cc IQR [100.00, 300.00] vs 200.00cc IQR [100.00, 400.00] in the CG (P<0.05). A multivariate regression considering age>75, DRE, GS, PSA, cardiovascular history and diabetes showed none of variables associated with early BCR. Limitations are retrospective design, small number of patients and short follow-up. CONCLUSIONS RARP shows similar perioperative, oncologic and functional outcomes for older patients selected by a CGA when compared to younger patients. The SG shows a minor perioperative bleeding. LEVEL OF EVIDENCE IV.
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Adenocarcinoma of the bladder: Assessment of survival benefit associated with radical cystectomy and comparison with urothelial bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Three-dimensional prostate model use and augmented reality guided frozen section analysis during robot-assisted radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Does the time from spinal cord injury affect the sperm retrieval rate in testicular sperm extraction? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Contemporary conditional cancer-specific survival rates in stage III non-seminoma testis cancer patients: A population-based analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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New size cut-off proposed by EAU Renal Cancer Working group better identifies patients who can benefit from local tumor ablation. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Cancer-specific mortality free survival rates in non-metastatic non-clear cell renal carcinoma patients at intermediate/high risk of recurrence. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Added value of MRI radiomics to predict pathological status of prostate cancer patients. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Radio-guided surgery with DROP-IN beta probe for 68Ga-PSMA, in high-risk prostate cancer patients eligible for robotic-assisted radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Predicting the risk of biochemical recurrence at five years in patients treated with radical prostatectomy for prostate cancer: The PIPEN categories. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Evaluating the impact of complications on survival outcomes in patients treated with radical cystectomy for bladder cancer. Results from a European multi-institutional collaboration (YAU Urothelial Cancer Group). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Differences in survival of clear cell metastatic renal cell carcinoma patients according to partial vs. radical nephrectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sarcomatoid vs. urothelial bladder cancer: Impact of radical cystectomy on cancer control outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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High-performance prediction models for prostate cancer radiomics. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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The impact of histology and type of energy used on oncological outcomes after local tumor ablation of small renal masses. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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PERC-score as a nephrometry scoring system in percutaneous tumour ablation: Comparison with RENAL, mRENAL, PADUA and SPARE in a multi-centre series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Effect of body mass index and obesity on perioperative and oncological outcomes in patients treated with thermal ablation for T1 renal cell tumors. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Differences in oncological outcomes in patients treated with thermal ablation for T1 renal cell masses: complete ablation vs. partial ablation +/- immediate re-treatment. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Evaluating the impact of complications on survival outcomes in patients treated with radical cystectomy for bladder cancer. Results from an european multi-institutional collaboration (YAU urothelial cancer group). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Preoperative predictors of postoperative complications after robot-assisted and laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Thermal ablation for small renal masses: identifying anthropometric predictors of surgical and oncologic outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Perc-score as a nephrometry scoring system in percutaneous tumour ablation: comparison with renal, mrenal, padua and spare in a multi-centre series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Association between histology and oncological outcomes or complication rates in patients treated with thermal ablation for T1 renal cell tumours. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Radical Nephroureterectomy Tetrafecta: A Proposal Reporting Surgical Strategy Quality at Surgery. EUR UROL SUPPL 2022; 42:1-8. [PMID: 35911084 PMCID: PMC9334825 DOI: 10.1016/j.euros.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Standardized methods for reporting surgical quality have been described for all the major urological procedures apart from radical nephroureterectomy (RNU). Objective To propose a tetrafecta criterion for assessing the quality of RNU based on a consensus panel within the Young Association of Urology (YAU) Urothelial Group, and to test the impact of this tetrafecta in a multicenter, large contemporary cohort of patients treated with RNU for upper tract urothelial carcinoma (UTUC). Design, setting, and participants This was a retrospective analysis of 1765 patients with UTUC treated between 2000 and 2021. Outcome measurements and statistical analysis We interviewed the YAU Urothelial Group to propose and score a list of items to be included in the “RNU-fecta.” A ranking was generated for the criteria with the highest sum score. These criteria were applied to a large multicenter cohort of patients. Kaplan-Meier curves were built to evaluate differences in overall survival (OS) rates between groups, and a multivariable logistic regression model was used to find the predictors of achieving the RNU tetrafecta. Results and limitations The criteria with the highest score included three surgical items such as negative soft tissue surgical margins, bladder cuff excision, lymph node dissection according to guideline recommendations, and one oncological item defined by the absence of any recurrence in ≤12 mo. These items formed the RNU tetrafecta. Within a median follow-up of 30 mo, 52.6% of patients achieved the RNU tetrafecta. The 5-yr OS rates were significantly higher for patients achieving tetrafecta than for their counterparts (76% vs 51%). Younger age, lower body mass index, and robotic approach were found to be independent predictors of tetrafecta achievement. Conversely, a higher Eastern Cooperative Oncology Group score, higher clinical stage, and bladder cancer history were inversely associated with tetrafecta. Conclusions Herein, we present a “tetrafecta” composite endpoint that may serve as a potential tool to assess the overall quality of the RNU procedure. Pending external validation, this tool could allow a comparison between surgical series and may be useful for assessing the learning curve of the procedure as well as for evaluating the impact of new technologies in the field. Patient summary In this study, a tetrafecta criterion was developed for assessing the surgical quality of radical nephroureterectomy in patients with upper tract urothelial carcinoma. Patients who achieved tetrafecta had higher 5-yr overall survival rates than those who did not.
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PO-1360 Nutritional and inflammatory status as predictive biomarkers in oligorecurrent PCa (RADIOSA TRIAL). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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PD-0412 Impact of adjuvant radiotherapy on biochemical recurrence rates for pn1 prostate cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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PO-1482 Estimation of inter-fraction motion of pelvic organs in SBRT treatments of prostate oligometastases. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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MO-0551 Short-term RT for early PCa with concomitant boost to the DIL (phase II trial AIRC-IG-13218)-updates. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Validation of the recommended size cut-off for thermal ablation in T1 renal cell carcinoma patients, according to the EAU Guidelines. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Diagnosis of prostate cancer in men treated with 5-alpha-reducates inhibitors with multi-parametric MRI: Results of a multicenter international collaboration. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Conditional survival of patients with low-risk prostate cancer: Temporal changes in active surveillance permanence according to risk stratification. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peri-operative complications in patients treated with thermal ablation for T1 renal cell tumors: Descriptive analysis and independent predictors. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Inguinal lymph node dissection for penile cancer: Results of a minimally invasive approach from a multicenter database. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diagnostic accuracy of preoperative lymph node staging of bladder cancer according to different lymph node locations: A multicenter cohort from the European Association of Urology – Young Academic Urologists. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Robot-assisted Diverticulectomy for an early-stage squamous cell carcinoma of the bladder. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Oncologic surveillance for variant histology bladder cancer after radical cystectomy. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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PO-1359 PORT impact on biochemical recurrence in pN1 PCa patients: establishing the appropriate RT timing. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Active surveillance for prostate cancer: Comparison between incidental tumors vs. tumors diagnosed at prostate biopsies. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Radical nephroureterectomy pentafecta: A proposal for standardisation of oncologic outcomes reporting following open, laparoscopic or robot-assisted radical nephroureterectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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42
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Outcomes of serial multiparametric magnetic resonance imaging in patients managed with active surveillance for prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how? Clin Transl Oncol 2021; 23:1717-1726. [PMID: 33687659 DOI: 10.1007/s12094-021-02574-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. PATIENTS AND METHODS A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. RESULTS From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. CONCLUSION The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.
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A novel nomogram predicting lymph node invasion among patients with prostate cancer: The importance of extracapsular extension at multiparametric magnetic resonance imaging. Urol Oncol 2021; 39:431.e15-431.e22. [PMID: 33423938 DOI: 10.1016/j.urolonc.2020.11.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To develop a novel risk tool that allows the prediction of lymph node invasion (LNI) among patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND). METHODS We retrospectively identified 742 patients treated with RARP + ePLND at a single center between 2012 and 2018. All patients underwent multiparametric magnetic resonance imaging (mpMRI) and were diagnosed with targeted biopsies. First, the nomogram published by Briganti et al. was validated in our cohort. Second, three novel multivariable logistic regression models predicting LNI were developed: (1) a complete model fitted with PSA, ISUP grade groups, percentage of positive cores (PCP), extracapsular extension (ECE), and Prostate Imaging Reporting and Data System (PI-RADS) score; (2) a simplified model where ECE score was not included (model 1); and (3) a simplified model where PI-RADS score was not included (model 2). The predictive accuracy of the models was assessed with the receiver operating characteristic-derived area under the curve (AUC). Calibration plots and decision curve analyses were used. RESULTS Overall, 149 patients (20%) had LNI. In multivariable logistic regression models, PSA (OR: 1.03; P= 0.001), ISUP grade groups (OR: 1.33; P= 0.001), PCP (OR: 1.01; P= 0.01), and ECE score (ECE 4 vs. 3 OR: 2.99; ECE 5 vs. 3 OR: 6.97; P< 0.001) were associated with higher rates of LNI. The AUC of the Briganti et al. model was 74%. Conversely, the AUC of model 1 vs. model 2 vs. complete model was, respectively, 78% vs. 81% vs. 81%. Simplified model 1 (ECE score only) was then chosen as the best performing model. A nomogram to calculate the individual probability of LNI, based on model 1 was created. Setting our cut-off at 5% we missed only 2.6% of LNI patients. CONCLUSIONS We developed a novel nomogram that combines PSA, ISUP grade groups, PCP, and mpMRI-derived ECE score to predict the probability of LNI at final pathology in RARP candidates. The application of a nomogram derived cut-off of 5% allows to avoid a consistent number of ePLND procedures, missing only 2.6% of LNI patients. External validation of our model is needed.
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PO-1197: Short-term high precision RT for early PCa with SIB to the DIL: QoL assessment (AIRC IG 13218). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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PO-1576: Assessment of mpMRI-based radiomics tools in PCa for cancer aggressiveness prediction, AIRC IG-. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Predictors of trifecta after open and robot partial nephrectomy for highly complex localized renal tumor: results from a large multicenter international prospective observational project (the surface-intermediate-base margin score consortium). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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48
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Robot-assisted intracorporeal orthotopic ileal neobladder: Description of the “Shell” technique. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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MRI-targeted or standard biopsy for prostate cancer diagnosis in biopsy naïve patients. The PRECISION trial follow-up. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Adding systematic biopsy (SBx) to magnetic resonance ultrasound fusion targeted biopsy (TBx) of the prostate in men with previous negative biopsy or enrolled in active surveillance programs: A prospective single center, randomized, analysis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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