Multiparametric MRI lesion dimension as a significant predictor of positive surgical margins following laparoscopic radical prostatectomy for transitional zone prostate cancer.
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引用次数: 0
Abstract
Background: Positive surgical margins (PSM) after laparoscopic radical prostatectomy are a critical factor influencing treatment outcomes and prognosis in prostate cancer. Optional treatment strategies (neoadjuvant therapy, surgical techniques) and intraoperative margin monitoring highlight the importance of PSM risk assessment. This study aims to evaluate the potential PSM risk in transitional zone (TZ) tumors.
Materials and methods: This retrospective study included 434 patients who underwent laparoscopic radical prostatectomy after multiparametric magnetic resonance imaging at our center between 2019 and 2023.
Results: The PSM rate was significantly higher in patients with TZ lesions compared to those with peripheral zone lesions (47%, n = 175 vs. 28%, n = 226, p < 0.01). Lesion location in TZ (OR: 4.29, 97.5% CI: 2.60-7.23, p < 0.01) was identified as independent risk factors for PSM. Further analysis identified largest dimension of lesions (OR: 1.27, 97.5% CI: 1.09-1.50, p < 0.01) and the number of positive biopsy cores (OR: 1.39, 97.5% CI: 1.16-1.70, p < 0.01) as independent risk factors for PSM in patients with TZ tumors. LASSO regression identified four significant variables (largest dimension of lesions-the most important variable, number of positive biopsy cores, prostate-specific antigen density, and International Society of Urological Pathology grade). These variables were used to construct three PSM risk prediction models, each demonstrating favorable predictive accuracy and clinical benefit.
Conclusions: Certain TZ prostate cancer patients demonstrate a higher predisposition to PSM occurrence. Lesion dimension as a significant predictor of PSM for TZ patients. Separate PSM risk assessments for subgroups, like TZ prostate cancer patients, may enhance predictive accuracy and clinical utility.
Clinical trial registration: China Clinical Trial Registry (ChiCTR2300075944, 2023).
背景：腹腔镜根治性前列腺切除术后阳性切缘（PSM）是影响前列腺癌治疗结果和预后的关键因素。可选择的治疗策略（新辅助治疗、手术技术）和术中切缘监测突出了PSM风险评估的重要性。本研究旨在评估PSM在过渡带（TZ）肿瘤中的潜在风险。材料和方法：本回顾性研究纳入了2019年至2023年在我中心接受多参数磁共振成像后行腹腔镜根治性前列腺切除术的434例患者。结果：TZ病变患者的PSM发生率明显高于周围带病变患者（47%,n = 175 vs. 28%, n = 226, p）。结论：某些TZ前列腺癌患者具有更高的PSM发生易感。病变尺寸是TZ患者PSM的重要预测因子。单独对亚组进行PSM风险评估，如TZ前列腺癌患者，可能会提高预测的准确性和临床实用性。临床试验注册：中国临床试验注册中心（ChiCTR2300075944, 2023）。
期刊介绍：
The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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