Predictive factors of extraprostatic extension after robot-assisted radical prostatectomy(with surgical video)
Objective:To retrospectively explore the risk factors of extraprostatic extension(EPE)after robot-assisted radical prostatectomy(RARP)to guide treatment decision making.Methods:Clinical data of patients who underwent RARP in Hunan Provincial People's Hospital from March 2019 to December 2022 were collected,including patient age,prostate-specific antigen(PSA),prostate volume(PV),prostate imaging-reporting and data system(PI-RADS),tumor percentage of the highest biopsy score,Gleason score of prostate biopsy,and pathological results after radical prostatectomy.Univariate and multivariate Logistic regression analyses were conducted to identify risk factors for extraprostatic extension after RARP.Receiver operating characteristic(ROC)curve analysis was used to compare the predictive values of each risk factor.Results:A total of 55 patients were included in the study,33 cases of EPE occurred after RARP.Univariate analysis results showed a significant relation between age,PI-RADS score,biopsy Gleason score,perineural invasion in biopsy,the tumor percentage of the highest biopsy score,and the presence of EPR after RARP(P<0.05).Multivariate analysis indicated that PSA,PI-RADS,biopsy Gleason score,and the tumor percentage of the highest biopsy score were independent risk factors for EPR after RARP.The AUC values of the above four risk factors were 0.57,0.67,0.83,and 0.84,respectively.The highest predictive value(AUC=0.861)for EPE was achieved when the three factors(PI-RADS,biopsy Gleason score,and tumor percentage of the highest biopsy score)combined,with a sensitivity of 0.61 and specificity of 0.96.Conclusion:The PI-RADS,PSA level,tumor percentage of the highest biopsy score,and biopsy Gleason score are independent risk factors for ECE,and comprehensive analysis of PI-RADS,biopsy Gleason score and the tumor percentage of the highest biopsy score can improve the predictive accuracy of ECE.
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