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. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd. KEYWORDS: extracapsular extension; nomogram; prostate; prostate cancer; robotic prostatectomy; staging

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy / Patel, Vipul R.; Sandri, Marco; Grasso, Angelica A. C.; De Lorenzis, Elisa; Palmisano, Franco; Albo, Giancarlo; Coelho, Rafael F.; Mottrie, Alexander; Harvey, Tadzia; Kameh, Darian; Palayapalayam, Hariharan; Wiklund, Peter; Bosari, Silvano; Puliatti, Stefano; Zuccolotto, Paola; Bianchi, Giampaolo; Rocco, Bernardo. - In: BJU INTERNATIONAL. - ISSN 1464-4096. - (2018), pp. 373-382. [10.1111/bju.14026]

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

Sandri, Marco;Puliatti, Stefano;Bianchi, Giampaolo;Rocco, Bernardo
2018-01-01

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. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd. KEYWORDS: extracapsular extension; nomogram; prostate; prostate cancer; robotic prostatectomy; staging
22-ott-2017
373
382
A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy / Patel, Vipul R.; Sandri, Marco; Grasso, Angelica A. C.; De Lorenzis, Elisa; Palmisano, Franco; Albo, Giancarlo; Coelho, Rafael F.; Mottrie, Alexander; Harvey, Tadzia; Kameh, Darian; Palayapalayam, Hariharan; Wiklund, Peter; Bosari, Silvano; Puliatti, Stefano; Zuccolotto, Paola; Bianchi, Giampaolo; Rocco, Bernardo. - In: BJU INTERNATIONAL. - ISSN 1464-4096. - (2018), pp. 373-382. [10.1111/bju.14026]
Patel, Vipul R.; Sandri, Marco; Grasso, Angelica A. C.; De Lorenzis, Elisa; Palmisano, Franco; Albo, Giancarlo; Coelho, Rafael F.; Mottrie, Alexander; Harvey, Tadzia; Kameh, Darian; Palayapalayam, Hariharan; Wiklund, Peter; Bosari, Silvano; Puliatti, Stefano; Zuccolotto, Paola; Bianchi, Giampaolo; Rocco, Bernardo
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