Preoperative Factors Predictive of Posterolateral Extracapsular Extension After Radical Prostatectomy
박사현, 박세준, Ryu Je-Man, 홍성우, 송상훈, 유달산, 정인갑, 송채린, 홍준혁, 김청수, 안한중,
소속 상세정보
박사현 ( Pak Sa-Hyun )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
박세준 ( Park Se-Jun )
University of Ulsan College of Medicine Department of Urology
( Ryu Je-Man )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
홍성우 ( Hong Sung-Woo )
Dankook University College of Medicine Department of Urology
송상훈 ( Song Sang-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
유달산 ( You Dal-San )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
정인갑 ( Jeong In-Gab )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
송채린 ( Song Che-Ryn )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
홍준혁 ( Hong Jun-Hyuk )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
김청수 ( Kim Choung-Soo )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
안한중 ( Ahn Han-Jong )
University of Ulsan College of Medicine Asan Medical Center Department of Urology
KMID : 0358320130540120824
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.
키워드
Magnetic resonance imaging; Prostatectomy; Prostatic neoplasms
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