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  • Goemaere, Natascha N. T.  (2)
  • den Bakker, Michael A.  (2)
  • 2020-2024  (2)
  • 1
    Online Resource
    Online Resource
    NeuroSAFE in radical prostatectomy increases the rate of nerve‐sparing surgery without affecting oncological outcome
    Wiley ; 2022
    In:  BJU International Vol. 130, No. 5 ( 2022-11), p. 628-636
    Details
    In: BJU International, Wiley, Vol. 130, No. 5 ( 2022-11), p. 628-636
    Abstract: To investigate the impact of intra‐operative neurovascular structure‐adjacent frozen‐section examination (NeuroSAFE) on the rate of nerve‐sparing surgery (NSS) and oncological outcome in a large radical prostatectomy (RP) cohort. Patients and methods Between January 2016 and December 2020, 1756 prostate cancer patients underwent robot‐assisted RP, of whom 959 (55%) underwent this with NeuroSAFE and 797 (45%) without (control cohort). In cases where NeuroSAFE showed tumour in the margin, a secondary resection was performed. The effect of NeuroSAFE on NSS and positive surgical margin (PSM) status was analysed using logistic regression. Cox regression was used to identify predictors of biochemical recurrence‐free survival (BCRFS). Results and limitations Patients in the NeuroSAFE cohort had a higher tumour grade ( P 〈  0.001) and clinical stage ( P 〈  0.001) than those in the control cohort. NeuroSAFE enabled more frequent NSS for both pT2 (93% vs 76%; P 〈  0.001) and pT3 disease (83% vs 55%; P 〈  0.001). In adjusted analysis, NeuroSAFE resulted in more frequent unilateral (odds ratio [OR] 3.90, 95% confidence interval (CI) 2.90–5.30; P 〈  0.001) and bilateral (OR 5.22, 95% CI 3.90–6.98; P 〈  0.001) NSS. While the PSM rate decreased from 51% to 42% in patients with pT3 stage disease ( P = 0.031), NeuroSAFE was not an independent predictor of PSM status (OR 0.85, 95% CI 0.68–1.06; P = 0.2) in the entire cohort. Patients who underwent NeuroSAFE had better BCRFS compared to the control cohort (hazard ratio 0.62, 95% CI 0.45–0.84; P = 0.002). This study is limited by its comparison with a historical cohort and lack of functional outcomes. Conclusions NeuroSAFE enables more unilateral and bilateral NSS without negatively affecting surgical margin status and biochemical recurrence. This validation study provides a comprehensive overview of the implementation, evaluation and intra‐operative decision making associated with NeuroSAFE in clinical practice.
    Type of Medium: Online Resource
    ISSN: 1464-4096 , 1464-410X
    URL: Issue
    URL: Article
    DOI: 10.1111/bju.v130.5
    DOI: 10.1111/bju.15771
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2019983-1
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  • 2
    Online Resource
    Online Resource
    Inter-observer variability of cribriform architecture and percent Gleason pattern 4 in prostate cancer: relation to clinical outcome
    Springer Science and Business Media LLC ; 2021
    In:  Virchows Archiv Vol. 478, No. 2 ( 2021-02), p. 249-256
    Details
    In: Virchows Archiv, Springer Science and Business Media LLC, Vol. 478, No. 2 ( 2021-02), p. 249-256
    Abstract: The Grade group is an important parameter for clinical decision-making in prostate cancer. Recently, percent Gleason pattern 4 and presence of invasive cribriform and/or intraductal carcinoma (CR/IDC) have been recognized for their independent predictive value for prostate cancer outcome. There is sparse data on the inter-observer agreement for these pathologic features in practice. Our objectives were to investigate inter-observer variability of percent Gleason pattern and CR/IDC and to relate individual tumour scores to clinical outcome. Our cohort included 80 consecutive radical prostatectomies with a median follow-up 87.1 months (interquartile range 43.3–119.2), of which the slide with largest tumour volume was scored by six pathologists for Grade group (four tiers: 1, 2, 3 and 4/5), percent Gleason pattern 4 (four tiers: 0–25%, 26–50%, 51–75% and 76–100%) and presence of CR/IDC (two tiers: absent, present). The individual assignments were related to post-operative biochemical recurrence (20/80). Inter-observer agreement was substantial (Krippendorff’s α 0.626) for assessment of Grade group and moderate for CR/IDC ( α 0.507) and percent Gleason pattern 4 ( α 0.551). For each individual pathologist, biochemical recurrence rates incremented by Grade group and presence of CR/IDC, although such relation was less clear for percent Gleason pattern 4. In conclusion, inter-observer agreement for CR/IDC and percent Gleason pattern 4 is lower than for Grade groups, indicating awareness of these features needs further improvement. Grade group and CR/IDC, but not percent Gleason pattern 4 was related to biochemical recurrence for each pathologist, indicating overall validity of individual grade assignments despite inter-observer variability.
    Type of Medium: Online Resource
    ISSN: 0945-6317 , 1432-2307
    URL: Article
    DOI: 10.1007/s00428-020-02902-9
    RVK:
    XA 27000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1463276-7
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