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Safe-R: a novel score, accounting for oncological safe nerve-sparing at radical prostatectomy for localized prostate cancer

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Abstract

Objectives

The objectives of the study were to describe a novel score (safe-R), combining information on surgical margin status (SM) and extend of nerve-sparing (NS) applicable for all patients undergoing radical prostatectomy (RP), and to test the impact of our frozen-section navigated nerve-sparing approach (NeuroSAFE) on safe-R score.

Methods

We retrospectively analyzed 9,635 RPs performed at our center between 2002 and 2011. Of these, 47 % were conducted with NeuroSAFE. Proportions of NS and SM status were assessed. Subsequently, a score for oncological safe NS (safe-R) was developed; Safe-R was categorized as 3 (for negative SM and bilateral NS), 2 (for negative SM and unilateral NS), 1 (for negative SM without NS), and 0 (for patients with positive SM), respectively. The impact of NeuroSAFE on safe-R was analyzed by chi-square test and confirmed by multinomial logistic regression, adjusting for preoperative risk factors.

Results

Applying NeuroSAFE resulted in enhanced safe-R score, indicating lower rates of positive SM and higher rates of NS, across all risk categories (all p < 0.001). For example in high-risk patients, NeuroSAFE resulted in lower proportions of safe-R 0 (27.6 vs. 33.6 %) and higher proportions of safe-R 3 (32.4 vs. 17.1 %, p < 0.001). Linkage between the NeuroSAFE approach and safe-R was confirmed after multinomial logistic adjustment for preoperative risk factors. All results were confirmed in a propensity-matched cohort (matched for preoperative risk factors and year of surgery, data not shown).

Conclusion

Safe-R represents a novel tool to assess and report on oncological safe nerve-sparing in RP. NeuroSAFE is associated with enhanced safe-R scores.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical standard

The authors confirm that the study has been performed in accordance with the ethical standards laid down in the Declaration of Helsinki 1964 and its later amendments. All patients gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Andreas Becker, Carolina Coelius, Meike Adam, Pierre Tennstedt, Thomas Steuber, Hans Heinzer, Markus Graefen, Thorsten Schlomm & Uwe Michl

  2. Department of Urology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany

    Andreas Becker, Meike Adam & Luis Kluth

Authors
  1. Andreas Becker
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  2. Carolina Coelius
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  3. Meike Adam
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  4. Pierre Tennstedt
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  5. Luis Kluth
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  6. Thomas Steuber
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  7. Hans Heinzer
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  8. Markus Graefen
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  9. Thorsten Schlomm
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  10. Uwe Michl
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Corresponding author

Correspondence to Andreas Becker.

Additional information

Andreas Becker and Carolina Coelius have contributed equally to this work.

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Becker, A., Coelius, C., Adam, M. et al. Safe-R: a novel score, accounting for oncological safe nerve-sparing at radical prostatectomy for localized prostate cancer. World J Urol 33, 77–83 (2015). https://doi.org/10.1007/s00345-014-1273-x

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  • DOI: https://doi.org/10.1007/s00345-014-1273-x

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