PMID- 17034506
OWN - NLM
STAT- MEDLINE
DCOM- 20070201
LR  - 20061127
IS  - 1464-4096 (Print)
IS  - 1464-4096 (Linking)
VI  - 98
IP  - 6
DP  - 2006 Dec
TI  - Surgical volume is related to the rate of positive surgical margins at radical 
      prostatectomy in European patients.
PG  - 1204-9
AB  - OBJECTIVE: To assess the association between surgical volume (SV) and the rate of 
      positive surgical margins (PSM) after radical prostatectomy (RP) in a large 
      single-institution European cohort of patients. PATIENTS AND METHODS: In all, 
      2402 men had a RP by a group of 11 surgeons, all of whom were trained by the 
      surgeon with the highest SV; all surgeons used the same surgical technique. 
      Variables assessed before RP were prostate-specific antigen (PSA) level, clinical 
      stage and biopsy Gleason sum; variables assessed after RP were PSA level, 
      extracapsular extension, seminal vesicle invasion, lymph node invasion and 
      pathological Gleason sum. These were used to predict the rate of PSM in models 
      before or after RP. Multivariate models were complemented with SV to test its 
      independent and multivariate statistical significance and to quantify its impact 
      on the model's overall (and 200 bootstrap-corrected) predictive accuracy. 
      RESULTS: The mean (range) SV was 201 (1-1293) RPs; the mean (median, range) rate 
      of PSM was 20.2 (21.4, 0-32.9)%. In multivariate models, SV was a highly 
      statistically significant independent predictor of PSM (P < 0.001) and increased 
      the predictive accuracy in multivariate models both before (2.0%) and after RP 
      (1.5%, both P < 0.001). However, when the surgeon with the highest SV, who 
      contributed to 1293 cases, was removed from the analyses, the multivariate 
      independent prediction and the gains in predictive accuracy related to adding SV, 
      disappeared in the models both before (P = 0.9, accuracy gain 0.1%) and after (P 
      = 0.4, accuracy gain - 0.3%) RP. CONCLUSIONS: These results indicate that 
      patients treated by surgeons with a very high volume can expect to have a 
      significantly lower rate of PSM, after accounting for clinical and pathological 
      case-mix differences. However, SV is not a predictor of PSM when analyses are 
      restricted to intermediate- and low-volume surgeons.
FAU - Chun, Felix K-H
AU  - Chun FK
AD  - Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, 
      Quebec, Canada.
FAU - Briganti, Alberto
AU  - Briganti A
FAU - Antebi, Elie
AU  - Antebi E
FAU - Graefen, Markus
AU  - Graefen M
FAU - Currlin, Eike
AU  - Currlin E
FAU - Steuber, Thomas
AU  - Steuber T
FAU - Schlomm, Thorsten
AU  - Schlomm T
FAU - Walz, Jochen
AU  - Walz J
FAU - Haese, Alexander
AU  - Haese A
FAU - Friedrich, Martin G
AU  - Friedrich MG
FAU - Ahyai, Sascha A
AU  - Ahyai SA
FAU - Eichelberg, Christian
AU  - Eichelberg C
FAU - Salomon, Georg
AU  - Salomon G
FAU - Gallina, Andrea
AU  - Gallina A
FAU - Erbersdobler, Andreas
AU  - Erbersdobler A
FAU - Perrotte, Paul
AU  - Perrotte P
FAU - Heinzer, Hans
AU  - Heinzer H
FAU - Huland, Hartwig
AU  - Huland H
FAU - Karakiewicz, Pierre I
AU  - Karakiewicz PI
LA  - eng
PT  - Journal Article
DEP - 20061011
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Clinical Competence/*standards
MH  - Cohort Studies
MH  - Europe
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Male
MH  - Multivariate Analysis
MH  - Neoplasm, Residual
MH  - Prognosis
MH  - Prospective Studies
MH  - Prostate-Specific Antigen/blood
MH  - Prostatectomy/standards/*statistics & numerical data
MH  - Prostatic Neoplasms/pathology/*surgery
MH  - Treatment Outcome
EDAT- 2006/10/13 09:00
MHDA- 2007/02/03 09:00
CRDT- 2006/10/13 09:00
PHST- 2006/10/13 09:00 [pubmed]
PHST- 2007/02/03 09:00 [medline]
PHST- 2006/10/13 09:00 [entrez]
AID - BJU6442 [pii]
AID - 10.1111/j.1464-410X.2006.06442.x [doi]
PST - ppublish
SO  - BJU Int. 2006 Dec;98(6):1204-9. doi: 10.1111/j.1464-410X.2006.06442.x. Epub 2006 
      Oct 11.