■最近,我们引入了一种名为"熟练程度评分"的创新工具来评估机器人辅助前列腺癌根治术(RARP)的学习曲线.然而,最初的研究仅针对不需要进行盆腔淋巴结清扫术(PLND)的低危前列腺癌患者.为了解决这个问题,我们旨在验证当代多中心队列高危前列腺癌患者的熟练程度评分,这些患者接受RARP加延长PLND治疗,由实习外科医生提供.
■在2010年至2020年之间,合并了4个意大利机构前列腺癌数据集,并查询了“RARP”和“高风险前列腺癌”。“根据最新的欧洲泌尿外科协会指南,高危前列腺癌的定义如下:前列腺特异性抗原>20ng/mL,国际泌尿外科病理学学会术前影像学≥4,和/或临床分期(cT)≥2c。所选择的队列(n=144)包括由实习外科医生(n=4)在完成他们的RARP学习曲线(50个低风险前列腺癌程序)后进行的临床病例。兴趣的结果,熟练程度得分,定义为以下所有标准的共存:与每个中心指导外科医生的四分位范围相当的手术时间,无任何重大围手术期并发症Clavien-Dindo3-5级,无围手术期输血,和阴性的手术切缘。建立了逻辑二元回归模型,以确定受训者队列中1年三连冠成绩的预测因素。对于所有统计分析,双侧p<0.05被认为是显著的。
■42.3%的患者达到熟练程度评分。在单一变量级别,熟练程度得分与1年三连冠成就相关(赔率比,8.77;95%置信区间,2.42-31.7;p=0.001)。在对年龄进行多变量调整后,保留神经,和手术技术,熟练程度得分独立预测1年三连冠成就(赔率比,9.58;95%置信区间,1.83-50.1;p=0.007)。
■我们的发现支持在患者中使用熟练程度评分,并且除了RARP外还需要延长PLND。
UNASSIGNED: Recently, an innovative tool called \"proficiency score\" was introduced to assess the learning curve for robot-assisted radical prostatectomy (RARP). However, the initial study only focused on patients with low-risk prostate cancer for whom pelvic lymph node dissection (PLND) was not required. To address this issue, we aimed to validate proficiency scores of a contemporary multicenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.
UNASSIGNED: Between 2010 and 2020, 4 Italian institutional prostate-cancer datasets were merged and queried for \"RARP\" and \"high-risk prostate cancer.\" High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows: prostate-specific antigen >20 ng/mL, International Society of Urological Pathology ≥4, and/or clinical stage (cT) ≥ 2c on preoperative imaging. The selected cohort (n = 144) included clinical cases performed by trainee surgeons (n = 4) after completing their RARP learning curve (50 procedures for low-risk prostate cancer). The outcome of interest, the proficiency score, was defined as the coexistence of all the following criteria: a comparable operation time to the interquartile range of the mentor surgeon at each center, absence of any significant perioperative complications Clavien-Dindo Grade 3-5, no perioperative blood transfusions, and negative surgical margins. A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort. For all statistical analyses, a 2-sided p < 0.05 was considered significant.
UNASSIGNED: A proficiency score was achieved in 42.3% patients. At univariable level, proficiency score was associated with 1-year trifecta achievement (odds ratio, 8.77; 95% confidence interval, 2.42-31.7; p = 0.001). After multivariable adjustments for age, nerve-sparing, and surgical technique, the proficiency score independently predicted 1-year trifecta achievement (odds ratio, 9.58; 95% confidence interval, 1.83-50.1; p = 0.007).
UNASSIGNED: Our findings support the use of proficiency scores in patients and require extended PLND in addition to RARP.