Variation in Positive Surgical Margin Status After Radical Prostatectomy for pT2 Prostate Cancer |
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Authors: | Wei Shen Tan Marieke J Krimphove Alexander P Cole Maya Marchese Sebastian Berg Stuart R Lipsitz Björn Löppenberg Junaid Nabi Firas Abdollah Toni K Choueiri Adam S Kibel Prasanna Sooriakumaran Quoc-Dien Trinh |
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Institution: | 1. Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;2. Division of Surgery and Interventional Science, University College London, London, United Kingdom;3. Department of Urology, University College London Hospitals, London, United Kingdom;4. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;5. Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany;6. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI;7. Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA |
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Abstract: | IntroductionWe evaluated patient, hospital, and cancer-specific factors associated with positive surgical margin (PSM) variability after radical prostatectomy in pT2 prostate cancer in the United States.Patients and MethodsA total of 45,426 men from 1152 hospitals with pT2 prostate cancer and known margin status after radical prostatectomy were identified using the National Cancer Database (2010-2015). Data on patient, cancer, hospital factors, and surgical approach were extracted. A mixed effects logistic regression model was computed to examine factors associated with PSM and partial R2 values to assess the relative contributions of patient, cancer, and hospital variables to PSM status.ResultsMedian PSM rate of 8.5% (interquartile range, 5.2%-13.0%). Robotic (odds ratio OR], 0.90; 95% confidence interval CI], 0.83-0.99) and laparoscopic (OR, 0.74; 95% CI, 0.64-0.90) surgical approach, academic institution (OR, 0.87; 95% CI, 0.76-1.00) and high hospital surgical volume (>297 cases OR], 0.83; 95% CI, 0.70-0.99) were independently associated with a lower PSM. Black men (OR, 1.13; 95% CI, 1.01-1.26) and adverse cancer-specific features (prostate-specific antigen PSA], 10-20; PSA >20; cT3 stage; Gleason 7, 8, 9-10; all P > .01) were independently associated with a higher PSM. Patient-specific, hospital-specific, and cancer-specific factors had a contribution of 2.3%, 3.9%, and 15.2%, respectively, to the variation in PSM. Facility had a contribution of 23.7% to the variation in PSM.ConclusionCancer-specific factors account for 15.2% of PSM variation with the remaining 84.8% of PSM variation due to patient, hospital, and other factors not accounted within the model. Noncancer-specific factors represent addressable factors that are important for policy-makers in efforts to improve patient outcome. |
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Keywords: | Address for correspondence: Quoc-Dien Trinh MD Center for Surgery and Public Health Division of Urological Surgery Brigham and Women’s Hospital Harvard Medical School 45 Francis St ASB II-3 Boston MA 02115 Localized Practice patterns Positive surgical margin Prostate cancer Radical prostatectomy |
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