Development of Risk-score Model in Patients with Negative Surgical Margin After Robot-assisted Radical Prostatectomy

Overview

Journal Sci Rep

Specialty Science

Date 2024 Mar 31

PMID 38556562

Authors

Yuta Yamada

Yoichi Fujii

Shigenori Kakutani

Naoki Kimura

Kazuma Sugimoto

Yuji Hakozaki

Toru Sugihara

Yuta Takeshima

Taketo Kawai

Masaki Nakamura

Jun Kamei

Satoru Taguchi

Yoshiyuki Akiyama

Yusuke Sato

Daisuke Yamada

Fumihiko Urabe

Hideyo Miyazaki

Yutaka Enomoto

Hiroshi Fukuhara

Tohru Nakagawa

Tetsuya Fujimura

Haruki Kume

Affiliations

Soon will be listed here.

Abstract

A total of 739 patients underwent RARP as initial treatment for PCa from November 2011 to October 2018. Data on BCR status, clinical and pathological parameters were collected from the clinical records. After excluding cases with neoadjuvant and/or adjuvant therapies, presence of lymph node or distant metastasis, and positive SM, a total of 537 cases were eligible for the final analysis. The median follow-up of experimental cohort was 28.0 (interquartile: 18.0-43.0) months. We identified the presence of International Society of Urological Pathology grade group (ISUP-GG) ≥ 4 (Hazard ratio (HR) 3.20, 95% Confidence Interval (95% CI) 1.70-6.03, P < 0.001), lymphovascular invasion (HR 2.03, 95% CI 1.00-4.12, P = 0.049), perineural invasion (HR 10.7, 95% CI 1.45-79.9, P = 0.020), and maximum tumor diameter (MTD) > 20 mm (HR 1.9, 95% CI 1.01-3.70, P = 0.047) as significant factors of BCR in the multivariate analysis. We further developed a risk model according to these factors. Based on this model, 1-year, 3-year, and 5-year BCR-free survival were 100%, 98.9%, 98.9% in the low-risk group; 99.1%, 94.1%, 86.5% in the intermediate-risk group; 93.9%, 84.6%, 58.1% in the high-risk group. Internal validation using the bootstrap method showed a c-index of 0.742 and an optimism-corrected c-index level of 0.731. External validation was also carried out using an integrated database derived from 3 other independent institutions including a total of 387 patients for the final analysis. External validation showed a c-index of 0.655. In conclusion, we identified risk factors of biochemical failure in patients showing negative surgical margin after RARP and further developed a risk model using these risk factors.

References

Menon M, Bhandari M, Gupta N, Lane Z, Peabody J, Rogers C . Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol. 2010; 58(6):838-46. DOI: 10.1016/j.eururo.2010.09.010. View

Sooriakumaran P, Haendler L, Nyberg T, Gronberg H, Nilsson A, Carlsson S . Biochemical recurrence after robot-assisted radical prostatectomy in a European single-centre cohort with a minimum follow-up time of 5 years. Eur Urol. 2012; 62(5):768-74. DOI: 10.1016/j.eururo.2012.05.024. View

Jung J, Lee J, Arkoncel F, Cho N, Md Yusoff N, Kim K . Significance of perineural invasion, lymphovascular invasion, and high-grade prostatic intraepithelial neoplasia in robot-assisted laparoscopic radical prostatectomy. Ann Surg Oncol. 2011; 18(13):3828-32. DOI: 10.1245/s10434-011-1790-4. View

Eichelberger L, Koch M, Daggy J, Ulbright T, Eble J, Cheng L . Predicting tumor volume in radical prostatectomy specimens from patients with prostate cancer. Am J Clin Pathol. 2003; 120(3):386-91. DOI: 10.1309/82U1-089X-LQGK-MMN1. View

Castiglione F, Delloglio P, Tosco L, Everaerts W, Albersen M, Hakim L . Tumor Volume and Clinical Failure in High-Risk Prostate Cancer Patients Treated With Radical Prostatectomy. Prostate. 2016; 77(1):3-9. DOI: 10.1002/pros.23242. View

Hansen J, Bianchi M, Sun M, Rink M, Castiglione F, Abdollah F . Percentage of high-grade tumour volume does not meaningfully improve prediction of early biochemical recurrence after radical prostatectomy compared with Gleason score. BJU Int. 2013; 113(3):399-407. DOI: 10.1111/bju.12424. View

Zhang L, Wu B, Zha Z, Zhao H, Yuan J, Jiang Y . Surgical margin status and its impact on prostate cancer prognosis after radical prostatectomy: a meta-analysis. World J Urol. 2018; 36(11):1803-1815. PMC: 6208659. DOI: 10.1007/s00345-018-2333-4. View

Rocco F, Rocco B . Anatomical reconstruction of the rhabdosphincter after radical prostatectomy. BJU Int. 2009; 104(2):274-81. DOI: 10.1111/j.1464-410X.2009.08751.x. View

You D, Jeong I, Song C, Cho Y, Hong J, Kim C . High percent tumor volume predicts biochemical recurrence after radical prostatectomy in pathological stage T3a prostate cancer with a negative surgical margin. Int J Urol. 2013; 21(5):484-9. DOI: 10.1111/iju.12348. View

10.

Choo M, Cho S, Jeong C, Lee S, Ku J, Hong S . Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy. Int J Urol. 2014; 21(9):894-8. DOI: 10.1111/iju.12465. View

11.

Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Miyazaki H, Nakagawa T . Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy. Int J Urol. 2017; 24(10):749-756. DOI: 10.1111/iju.13411. View

12.

van Oort I, Witjes J, Kok D, Kiemeney L, Hulsbergen-vandeKaa C . Maximum tumor diameter is not an independent prognostic factor in high-risk localized prostate cancer. World J Urol. 2008; 26(3):237-41. PMC: 2413091. DOI: 10.1007/s00345-008-0242-7. View

13.

Hashimoto T, Yoshioka K, Nagao G, Nakagami Y, Ohno Y, Horiguchi Y . Prediction of biochemical recurrence after robot-assisted radical prostatectomy: analysis of 784 Japanese patients. Int J Urol. 2014; 22(2):188-93. DOI: 10.1111/iju.12624. View

14.

Hashimoto T, Nakashima J, Inoue R, Komori O, Yamaguchi Y, Kashima T . The significance of micro-lymphatic invasion and pathological Gleason score in prostate cancer patients with pathologically organ-confined disease and negative surgical margins after robot-assisted radical prostatectomy. Int J Clin Oncol. 2019; 25(2):377-383. DOI: 10.1007/s10147-019-01561-4. View

15.

Di Pierro G, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A . A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol. 2010; 59(1):1-6. DOI: 10.1016/j.eururo.2010.10.026. View

16.

Chen S, Zhang B, Zhou B, Zhu C, Sun L, Feng Y . Perineural invasion of cancer: a complex crosstalk between cells and molecules in the perineural niche. Am J Cancer Res. 2019; 9(1):1-21. PMC: 6356921. View

17.

Zhou C, Check D, Lortet-Tieulent J, Laversanne M, Jemal A, Ferlay J . Prostate cancer incidence in 43 populations worldwide: An analysis of time trends overall and by age group. Int J Cancer. 2015; 138(6):1388-400. PMC: 4712103. DOI: 10.1002/ijc.29894. View

18.

Kang M, Oh J, Lee S, Hong S, Lee S, Byun S . Perineural Invasion and Lymphovascular Invasion are Associated with Increased Risk of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy. Ann Surg Oncol. 2016; 23(8):2699-706. DOI: 10.1245/s10434-016-5153-z. View

19.

Olar A, He D, Florentin D, Ding Y, Wheeler T, Ayala G . Biological correlates of prostate cancer perineural invasion diameter. Hum Pathol. 2014; 45(7):1365-9. PMC: 4492300. DOI: 10.1016/j.humpath.2014.02.011. View

20.

Fromont G, Godet J, Pires C, Yacoub M, Dore B, Irani J . Biological significance of perineural invasion (PNI) in prostate cancer. Prostate. 2011; 72(5):542-8. DOI: 10.1002/pros.21456. View