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Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Influence of pathologist experience on positive surgical margins following radical prostatectomy
Jacob E Tallman1, Vignesh T Packiam2, Kristen E Wroblewski3
1Pritzker School of Medicine, The University of Chicago, Chicago, IL.
Background:
A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs.
Methods:
We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates.
Results:
Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2).
Conclusions:
Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist.
Insights
Pathologist experience impacts positive surgical margins (PSMs) after prostate cancer surgery. More experienced pathologists were linked to higher PSM rates, suggesting a need for expert review.
Area of Science:
- Urology
- Pathology
- Oncology
Background:
- Positive surgical margins (PSMs) after radical prostatectomy (RP) increase prostate cancer recurrence risk.
- Predictors of PSMs are crucial for improving patient outcomes.
Purpose of the Study:
- To determine if pathologist experience independently predicts PSMs following RP.
- To analyze the association between pathologist experience and PSM rates.
Main Methods:
- Retrospective review of 3,557 radical prostatectomy cases (2003-2015).
- Evaluation of 29 pathologists and their experience levels.
- Univariate and multivariable logistic regression analyses to identify PSM predictors.
Main Results:
- Overall PSM rate was 18.9%.
- Increased pathologist experience was significantly associated with higher odds of PSMs (OR=1.11).
- Pathologist experience, surgeon experience, Gleason score, and PSA levels were significant predictors of PSMs.
Conclusions:
- Greater pathologist experience correlates with increased odds of PSMs post-RP.
- Consideration for re-review by dedicated genitourinary pathologists for less experienced pathologists is recommended.
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