病患疑似攝護腺癌接受治療診斷性達文西機器手臂輔助腹腔鏡根除性攝護腺切除術建立一個計算圖表預測病患得攝護腺癌
歐宴泉、黃立華、翁瑋駿、許兆畬、林益聖、童敏哲
童綜合醫院 外科部 泌尿科
Build A Nomogram for prediction of patients with prostate cancer at preoperatively suspicious prostate cancer receiving Theranostic robotic-Assisted laparoscopic radical prostatectomy
Yen Chuan Ou, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Shu, Yi-Sheng Lin, Min-Che Tung
Division of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Purpose: Expanded indications for preoperatively suspicious prostate cancer receiving Theranostic robotic-assisted laparoscopic radical prostatectomy (RARP) are previously reported. To analyze predictors of 153 cases of Theranostic RARP for preoperatively suspicious prostate cancer for final pathology proved prostate cancer.
Materials and Methods: This retrospective study reviewed data of a subset of 153 consecutive patients among 1580 patients who underwent RARP for preoperatively suspicious prostate cancer performed by the same surgeon from Dec. 2005 to Mar. 2018. Pathologic characteristics and outcomes of patients with suspected prostate cancer were analyzed and preoperative and intraoperative parameters were compared between three groups. Patients were stratified by final pathology reports of RARP specimens: Group I：Prostate cancer, N=69(45.1%); Group II: Abnormal (ASAP: atypical small acinar proliferation N=12; PIN: prostate intraepithelial neoplasia, N=35), N=47(30.7%); Group III: Benign (NH: nodular hyperplasia or inflammation), N=37(24.2%). Patients’ recorded preoperative demographic and clinical characteristics included age, body mass index (BMI), American Society of Anesthesiologists anesthetic/surgical risks class (ASA),PSA levels, Free /total PSA ratio, prostate volume, PSA density, history of acute urinary retention, abnormal DRE of prostate, PI-RADS (Prostate Imaging Reporting and Data System) classification at 3-T multiparametric (mp) MRI, Pateints having family history of prostate cancer and patients are medical personnel.
Results: We used Logistic regression with backward elimination to select out potential risk factors. According to Harrell’s guidelines, we chose 7 variables in our final model: Age, DRE corresponding MRI, AUR, PSAD, PSAV, PI RADS, and Biopsy pathology. The 95% confidence interval of the original C-index was obtained from 1000 bootstrap resampling. All statistical analyses were performed by using SAS software version 9.4 (SAS Institute INC., Carey, NC) and R (R Core Team 2017). A nomogram prediction adenocarcinoma was developed using data for 130 patients with MRI based on 7 parameters. The original c-index for the nomogram was 0.80 with 95% confidence interval (0.74, 0.89). The average c-index of the 1000 bootstrap resamples was 0.81.
Conclusions:
Prophylactic RARP with bilateral neurovascular bundle preservation is a safe and viable option for preoperatively suspicious prostate cancer performed by experienced surgeons. Preoperative, a nomogram prediction adenocarcinoma can help to explain patients and his family the possibility of prostate cancer for their decision-making. Our predictive nomogram need to validate by more cases and different cohort.