High surgeon volume and positive surgical margins can predict the risk of biochemical recurrence after robot-assisted radical prostatectomy

Antonio Benito Porcaro; Alessandro Tafuri; Marco Sebben; Nelia Amigoni; Tania Processali; Marco Pirozzi; Riccardo Rizzetto; Aliasger Shakir; Paolo Corsi; Leone Tiso; Clara Cerrato; Filippo Migliorini; Giovanni Novella; Matteo Brunelli; Riccardo Bernasconi; Vincenzo De Marco; Salvatore Siracusano; Walter Artibani

doi:10.1177/1756287219878283

High surgeon volume and positive surgical margins can predict the risk of biochemical recurrence after robot-assisted radical prostatectomy

Ther Adv Urol. 2019 Sep 24:11:1756287219878283. doi: 10.1177/1756287219878283. eCollection 2019 Jan-Dec.

Authors

Antonio Benito Porcaro¹, Alessandro Tafuri², Marco Sebben², Nelia Amigoni², Tania Processali², Marco Pirozzi², Riccardo Rizzetto², Aliasger Shakir³, Paolo Corsi², Leone Tiso², Clara Cerrato², Filippo Migliorini², Giovanni Novella², Matteo Brunelli⁴, Riccardo Bernasconi⁴, Vincenzo De Marco², Salvatore Siracusano², Walter Artibani²

Affiliations

¹ Department of Urology Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, Verona, 37126, Italy.
² Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
³ USC Institute of Urology, and Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

Abstract

Background: The aim of this study was to determine whether any clinical factors are independent predictors of positive surgical margins (PSM), and to assess the association of PSM and biochemical recurrence (BR) after robot-assisted radical prostatectomy (RARP).

Methods: The population included cases with negative surgical margins (control group) and patients with PSM (study group). Tumor grade was evaluated according to the International Society of Urologic Pathology (ISUP) system. A logistic regression model assessed the independent association of factors with the risk of PSM. The risk of BR was assessed by Cox's multivariate proportional hazards.

Results: A total of 732 consecutive patients were evaluated. Extend pelvic lymph node dissection (ePLND) was performed in 342 cases (46.7%). Overall, 192 cases (26.3%) had PSM. The risk of PSM was positively associated with the percentage of biopsy positive cores (BPC; odds ratio, OR = 1.012; p = 0.004), extracapsular extension (pT3a; OR=2.702; p < 0.0001), invasion of seminal vesicle (pT3b; OR = 2.889; p < 0.0001), but inversely with body mass index (OR = 0.936; p = 0.021), and high surgeon volume (OR = 0.607; p = 0.006). Independent clinical factors associated with the risk of BR were baseline prostate-specific antigen (PSA; hazard ratio, HR = 1.064; p = 0.004), BPC (HR = 1.015; p = 0.027), ISUP biopsy grade group (BGG) 2/3 (HR = 2.966; p = 0.003), and BGG 4/5 (HR = 3.122; p = 0.022). Pathologic factors associated with the risk of BR were ISUP group 4/5 (HR = 3.257; p = 0.001), pT3b (HR = 2.900; p = 0.003), and PSM (HR = 2.096; p = 0.045).

Conclusions: In our cohort, features related to host, tumor, and surgeon volume are associated with the risk of PSM, which is also an independent parameter predicting BR after RARP. The surgical volume of the operating surgeon is an independent factor that decreases the risk of PSM, and, as such, the risk of BR.

Keywords: biochemical recurrence; positive surgical margins; prostate cancer; robot-assisted radical prostatectomy; surgical volume.