|
KMID : 0358320130540120824
|
|
Korean Journal of Urology
2013 Volume.54 No. 12 p.824 ~ p.829
|
|
|
Preoperative Factors Predictive of Posterolateral Extracapsular Extension After Radical Prostatectomy
|
|
Pak Sa-Hyun
Park Se-Jun
Ryu Je-Man
Hong Sung-Woo
Song Sang-Hoon
You Dal-San
Jeong In-Gab
Song Che-Ryn
Hong Jun-Hyuk
Kim Choung-Soo
Ahn Han-Jong
|
|
|
Abstract
|
|
|
Purpose:In radical prostatectomy (RP) procedures, sparing the neurovascular bundles adjacent to the posterolateral aspect of the prostatic fascia has often been suggested as a possible risk factor for positive surgical margins. Here we aimed to quantify the probability of extracapsular extension (ECE) at the posterolateral side of the prostate to aid in nerve-sparing decision making.
Materials and Methods:We evaluated 472 patients who underwent RP between July 2007 and January 2012. All patients underwent preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient mapping. We analyzed 944 side-specific prostate lobes with preoperative variables. To quantify the risk of side-specific posterolateral ECE after RP, we developed a risk-stratification scoring system through logistic regression analysis.
Results:Overall, 20.6% of 944 prostate lobes had ECE. In the multivariate analysis, prostate-specific antigen (PSA), biopsy Gleason score ≥7, percentage of side-specific cores with tumor, and posterolateral ECE on MRI were independent predictive factors of posterolateral ECE. On internal and external validation to calculate the predicted risk, the Hosmer-Lemeshow goodness-of-fit test showed good calibration (p=0.396).
Conclusions:PSA, biopsy Gleason score, percentage of side-specific cores with tumor, and posterolateral ECE on MRI are independent predictors of posterolateral ECE. The scoring system derived from this study will provide objective parameters for use when deciding if the neurovascular bundle can be safely spared.
|
|
|
KEYWORD
|
|
|
Magnetic resonance imaging, Prostatectomy, Prostatic neoplasms
|
|
|
FullTexts / Linksout information
|
|
  
|
|
|
Listed journal information
|
|
  
|