Proficiency score as a predictor of early trifecta achievement during the learning curve of robot-assisted radical prostatectomy for high-risk prostate cancer:Results of a multicentric series  

作　　者：Umberto Anceschi Rocco Simone Flammia Antonio Tufano Michele Morelli Antonio Galfano Lorenzo Giuseppe Luciani Leonardo Misuraca Paolo Dell’Oglio Gabriele Tuderti Aldo Brassetti Maria Consiglia Ferriero Alfredo Maria Bove Riccardo Mastroianni Francesco Prata Isabella Sperduti Giovanni Petralia SilviaSecco Ettore Di Trapani DanieleMattevi Tommaso Cai Aldo Massimo Bocciardi Giuseppe Simone 

机构地区：[1]Department of Urology,IRCCS“Regina Elena”National Cancer Institute,Rome,Italy [2]Urologic Clinic,Department of Maternal-Child and Urologic Sciences,Sapienza University of Rome,Italy [3]Ospedale Niguarda Ca’Granda,Department of Urology,Milan,Italy [4]Department of Urology,APSS Santa Chiara Regional Hospital,Trento,Italy [5]Department of Biostatistical Unit,IRCCS Regina Elena National Cancer Institute,Rome,Italy

出　　处：《Current Urology》2024年第2期110-114,共5页当代泌尿学（英文）

摘　　要：Background: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 forwhompelvic lymph node dissection(PLND)was not required.To address this issue,we aimed to validate proficiency scores of a contemporarymulticenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.Material andmethods:Between 2010 and 2020,4 Italian institutional prostate-cancer datasets weremerged 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 ofUrological 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.Results: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)

关 键 词：Trifecta Learning curve Robot-assisted radical prostatectomy High-risk prostate cancer 

分 类 号：R737.25[医药卫生—肿瘤]