Staging Accuracy of Multiparametric Magnetic Resonance Imaging in Caucasian and African American Men Undergoing Radical Prostatectomy.
- 作者列表："Falagario UG","Ratnani P","Lantz A","Jambor I","Dovey Z","Verma A","Treacy PJ","Sobotka S","Martini A","Bashorun H","Ashan M","Wagaskar VG","Lewis S","Cormio L","Carrieri G","Kyprianou N","Mohamed N","Tewari A
PURPOSE:We compared the performance of multiparametric magnetic resonance imaging for the prediction of extraprostatic extension in African American and Caucasian American men and evaluated racial disparities in pathological outcomes after radical prostatectomy. MATERIALS AND METHODS:We identified 975 patients who underwent radical prostatectomy with preoperative multiparametric magnetic resonance imaging between January 2013 and April 2019 at our institution. Multivariable logistic regression analysis was performed predicting pathological extraprostatic extension, high grade prostate cancer (final pathology GGG [Gleason Grade Group] 3 or greater) in the overall population and pathological upgrading (final pathology GGG 3 or greater) in patients with a diagnosis of GGG 1-2 prostate cancer. Adverse pathology was defined as pT3 and/or GGG 3 or greater. RESULTS:A total of 221 (23%) patients were African American. Preoperatively 594 (60.9%) were GGG 1-2 (low risk group) and 381 (39.1%) GGG 3 or greater (high risk group). In the low risk group rates of pathological extraprostatic extension (18% vs 12.8%, p=0.14), adverse pathology (18% vs 13.4%, p=0.2) or upgrading (9.4% vs 12.1%, p=0.4) were similar between races. Similarly, in the high risk group there was no difference in rates of pathological extraprostatic extension. On multivariable analysis multiparametric magnetic resonance imaging predicted the presence of extraprostatic extension (OR 1.80, 95% CI 1.29-2.50) and high grade prostate cancer (OR 1.82, 95% CI 1.25-2.67) on final pathology. Conversely, race did not predict the outcomes of interest (all values p >0.05). Multiparametric magnetic resonance imaging showed comparable sensitivity (22.22% vs 27.84%), specificity (89.2% vs 79.2%), positive predictive value (89.2% vs 83.4%) and negative predictive value (89.2% vs 83.4%) between African American and Caucasian America men, respectively. CONCLUSIONS:The accuracy of multiparametric magnetic resonance imaging in staging prostate cancer was similar in African American and Caucasian American patients and no difference was found between races in pathological outcomes after radical prostatectomy. These findings suggest that access to and use of advanced diagnostic tests may help mitigate prostate cancer racial disparities.
目的: 我们比较了多参数磁共振成像预测非裔美国人和高加索美国人前列腺外延伸的性能，并评估了根治性前列腺切除术后病理结果的种族差异。 材料和方法: 我们在2013年1月至2019年4月期间在我们的机构中确定了975例接受根治性前列腺切除术的术前多参数磁共振成像的患者。进行多变量logistic回归分析，预测总体人群中病理前列腺外延伸、高级别前列腺癌 (最终病理GGG [Gleason分级组] 3或更高) 和诊断为GGG 1-2前列腺癌患者的病理升级 (最终病理GGG 3或更高)。不良病理定义为pT3和/或GGG 3或更高。 结果: 共有221例 (23%) 患者为非裔美国人。术前594 (60.9%) 为GGG 1-2 (低风险组)，381 (39.1%) 为GGG 3或更高 (高风险组)。在低风险组中，不同种族之间的病理前列腺外延伸率 (18% vs 12.8%，p = 0.14)，不良病理 (18% vs 13.4%，p = 0.2) 或升级 (9.4% vs 12.1%，p = 0.4) 相似。类似地，在高风险组中，病理前列腺外延伸的比率没有差异。根据多变量分析，多参数磁共振成像预测最终病理存在前列腺外延伸 (OR 1.80，95% CI 1.29-2.50) 和高级别前列腺癌 (OR 1.82，95% CI 1.25-2.67)。相反，种族不能预测感兴趣的结果 (所有值p >0.05)。多参数磁共振成像显示，非裔美国人和高加索裔美国人男性之间的灵敏度 (22.22% vs 27.84%)，特异性 (89.2% vs 79.2%)，阳性预测值 (89.2% vs 83.4%) 和阴性预测值 (89.2% vs 83.4%) 相当。 结论: 在非裔美国人和白种人中，多参数磁共振成像对前列腺癌分期的准确性相似，在根治性前列腺切除术后的病理结果中，种族之间没有发现差异。这些发现表明，获得和使用先进的诊断测试可能有助于减轻前列腺癌种族差异。
METHODS::Veterinary educators use models to allow repetitive practice of surgical skills leading to clinical competence. Canine castration is a commonly performed procedure that is considered a Day One competency for a veterinarian. In this study, we sought to create and evaluate a canine pre-scrotal closed castration model and grading rubric using a validation framework of content evidence, internal structure evidence, and relationship with other variables. Veterinarians (n = 8) and students (n = 32) were recorded while they performed a castration on the model and provided survey feedback. A subset of the students (n = 7) then performed a live canine castration, and their scores were compared with their model scores. One hundred percent of the veterinarians and 91% of the students reported that the model was helpful in training for canine castration. They highlighted several areas for continued improvement. Veterinarians' model performance scores were significantly higher than students', indicating that the model had adequate features to differentiate expert from novice performance. Students' performance on the model strongly correlated with their performance of live castration (r = .82). Surgical time was also strongly correlated (r = .70). The internal consistency of model and live rubric scores were good at .85 and .94, respectively. The framework supported validation of the model and rubric. The canine castration model facilitated cost-efficient practice in a safe environment in which students received instructor feedback and learned through experience without the risk of negatively affecting a patient's well-being. The strong correlation between model and live animal performance scores suggests that the model could be useful for mastery learning.
METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.
METHODS:PURPOSE:To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence after the laparoscopic and robot-assisted radical prostatectomies, and using control groups. MATERIALS AND METHODS:We included all original articles on studies providing data on inguinal hernia incidence in patients treated with radical prostatectomy for localized prostate cancer. PubMed® and EMBASE® were searched on February 28, 2018. A meta-analysis was done as a weighted and pooled estimate of the incidence of inguinal hernia. The bias risk was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration tool for randomized clinical trials. RESULTS:We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia was 13.7% (95% CI 12.0-15.4) after open retropubic radical prostatectomy, 7.5% (95% CI 5.2-9.8) after laparoscopic radical prostatectomy and 7.9% (95% CI 5.0-10.9) after robot-assisted laparoscopic radical prostatectomy. In studies comparing the incidence of inguinal hernia after open prostatectomy vs no treatment the incidence was significantly higher in the radical prostatectomy group (11.7%, 95% CI 9.2-14.2 vs 3.3%, 95% CI 2.0-4.6). Two of 3 studies showed a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomies compared with a control group. Most studies of intraoperative inguinal hernia prevention techniques demonstrated a significantly lower inguinal hernia incidence in the experimental group. Inguinal hernias that developed after radical prostatectomy were primarily indirect (81.9%, 95% CI 75.3-88.4). CONCLUSIONS:We found a high incidence of inguinal hernia following radical prostatectomy and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was noted after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomies. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy than in control groups with some evidence to support the same finding for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies of intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.