A Predictive Preoperative and Postoperative Nomogram for Postoperative Potency Recovery after Robot-Assisted Radical Prostatectomy
A Predictive Preoperative and Postoperative Nomogram for Postoperative Potency Recovery after Robot-Assisted Radical Prostatectomy
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DOI：
10.1097/ju.0000000000001895
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发表时间：
2021-10-01
影响因子：
6.6
通讯作者：
Patel, Vipul R.
中科院分区：
文献类型：
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作者：
Bhat, K. R. Seetharam;Moschovas, Marcio Covas;Patel, Vipul R.
目的：预测机器人辅助根治性前列腺切除术 (RARP) 后的效力恢复有助于更好的患者咨询和术后治疗策略。在本研究中，我们提出了术前和术后列线图来预测 RARP 术后效力恢复。材料和方法：选择开发组 (6,502) 中的患者来开发列线图，并使用验证组 (2,706) 中的患者进行验证。 Cox 回归模型适用于开发队列，以使用所选协变量作为预后因素来预测 RARP 后的效力恢复。使用术前和术后 Cox 模型的回归系数绘制两个列线图。结果：使用估计在 3、6、12 和 24 个月的受试者操作曲线对开发队列评估术前模型的辨别能力。这些时间点的 AUC 分别为 0.726、0.734、0.754 和 0.778。术后3、6、12和24个月时模型的曲线下面积分别为0.746、0.756和0.777和0.801。使用另一组 2,706 名患者对术前和术后预测模型进行了验证。术前模型在3、6、12和24个月时的AUC分别为0.789、0.772、0.768和0.778。术后模型3、6、12和24个月的ROC曲线，AUC分别为0.807、0.797、0.793和0.798。与年龄和术前性功能一起，神经保留技术决定了效力结果，证明术后模型与术前模型相比具有更好的 AUC。结论：上述列线图有助于我们在考虑术前和术后因素的情况下，准确地预测术后 3、6、12 和 24 个月内效力恢复的概率。这是护理人员在术前和术后立即咨询时预测患者效力结果的实际预期的一种新颖工具。
Purpose: Prediction of potency recovery following robot-assisted radical prostatectomy (RARP) is useful for better patient counseling and postoperative treatment strategies. In this study we propose a preoperative and postoperative nomogram to predict postoperative potency recovery following RARP.Materials and Methods: Patients from development set (6,502) were selected to develop the nomograms, and patients in validation set (2,706) were used for validation. Cox regression models were fitted on the development cohort to predict potency recovery after RARP using as prognostic factors the covariates selected. Two nomograms were drawn using the regression coefficients of the preoperative and postoperative Cox models.Results: The discrimination ability of the preoperative model was evaluated on the development cohort using the receiver operator curves estimated at 3, 6, 12 and 24 months. The AUC at these time points was 0.726, 0.734, 0.754, and 0.778, respectively. The areas under the curve of the postoperative model at 3, 6, 12 and 24 months were 0.746, 0.756 and 0.777, and 0.801, respectively. Preoperative and postoperative predictive models were validated using a separate set of 2,706 patients. The AUCs of the preoperative model at 3, 6, 12 and 24 months were 0.789, 0.772, 0.768, and 0.778, respectively. The ROC curves of the postoperative model at 3, 6, 12 and 24 months with AUCs of 0.807, 0.797, 0.793 and 0.798, respectively. Along with age and preoperative sexual function, nerve-sparing technique determines the potency outcomes justifying better AUC for postoperative model vs the preoperative model.Conclusions: The above nomograms help us to predict with good accuracy the probability of potency recovery within 3, 6, 12 and 24 months following surgery taking into consideration preoperative and postoperative factors. This is a novel tool for the care giver to predict realistic expectation of potency outcomes to the patients, while preoperative and immediate postoperative counseling.