解放军医学院学报2025，Vol.46Issue(6)：560-566,7.DOI:10.12435/j.issn.2095-5227.25012702
中低危前列腺癌患者行机器人辅助前列腺癌根治术后病理分期升级及关联因素研究
Factors associated with pathological staging upgrade after RARP in patients with intermediate and low-risk prostate cancer
符宗宇 1安子彦 1邵金鹏 1陈冠球 1叶洲杰 2赵堃 1邹昊逾 2符伟军3
作者信息
- 1. 解放军医学院,北京 100853
- 2. 南开大学医学院,天津 300071
- 3. 解放军总医院第三医学中心泌尿外科医学部,北京 100039
- 折叠
摘要
Abstract
Background The pathological stage after robot-assisted radical prostatectomy(RARP)affects the prognosis of patients.However,factors affect the upstaging of low-intermediate risk prostate cancer(PCa)after RARP remain unclear.Objective To analyze the independent risk factors of pathological stage upstaging after RARP in patients with low-intermediate risk PCa,and construct and validate a prediction model.Methods A retrospective analysis was conducted on the clinical data about 215 patients with low-intermediate risk PCa who underwent RARP at The First Medical Center of PLA General Hospital from January 2017 to December 2023.The pathological stage upstaging was defined as the clinical stage T1-T2,while the postoperative pathological stage was pT3-T4.Logistic regression analysis was utilized to identify factors linked to pathological stage upstaging and to develop a predictive model.The prediction model was evaluated by area under curve(AUC)of receiver operating characteristic curve(ROC),calibration curve and decision curve analysis.A 1000-time Bootstrap resampling strategy was employed for internal validation.The clinical data about the same type of patients in The Third Medical Center of PLA General Hospital from January 2022 to June 2024 were used for external validation.Results Among the 215 patients included in the study,37 cases(17.2%)presented with pathological stage upstaging after the operation.According to univariate logistic regression analysis,significant differences were observed in the prostate volume,the PSA density(PSAD),the percentage of positive biopsies,the ISUP grade on biopsy,and the clinical stage between the two groups(P＜0.05).Multivariate logistic regression analysis identified prostate volume(OR=0.954,95%CI:0.922-0.988,P=0.008),positive biopsy percentage≥30%(OR=3.697,95%CI:1.345-10.163,P=0.011),and biopsy ISUP grade 3(OR=2.988,95%CI:1.110-8.043,P=0.030)as risk factors for pathological stage upstaging.The internal validation AUC was 0.790(95%CI:0.707-0.867),and the external validation AUC was 0.737(95%CI:0.575-0.890).The calibration curves for both internal and external validation demonstrated good consistency.DCA results suggested that the nomogram model provided a higher net clinical benefit within the threshold range.Conclusion The novel nomogram,developed using prostate volume,the percentage of positive biopsy cores,and the ISUP grade on biopsy,can accurately predict pathological stage upstaging.This model demonstrates favorable predictive performance through both internal and external validation.关键词
前列腺癌/机器人辅助前列腺癌根治术/病理分期升级/预测模型/列线图/内部验证/外部验证Key words
prostate cancer/robot-assisted radical prostatectomy/pathological stage upstaging/prediction model/nomograph/internal verification/external verification分类
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符宗宇,安子彦,邵金鹏,陈冠球,叶洲杰,赵堃,邹昊逾,符伟军..中低危前列腺癌患者行机器人辅助前列腺癌根治术后病理分期升级及关联因素研究[J].解放军医学院学报,2025,46(6):560-566,7.
