Objective

To clarify the composition of lesions in different magnetic resonance imaging (MRI) partitions of positive surgical margins (PSM) after laparoscopic radical prostatectomy, explore the influence of lesion location on PSM, and construct a clinical prediction model to predict the risk of PSM.

Materials and methods

This retrospective cohort study included 309 patients who underwent laparoscopic radical prostatectomy from 2018 to 2021 in our center was performed. 129 patients who met the same criteria from January to September 2022 were external validation cohorts.

Results

The incidence of PSM in transition zone (TZ) lesions was higher than that in peripheral zone (PZ) lesions. The incidence of PSM in the middle PZ was lower than that in other regions. Prostate specific antigen (PSA), clinical T-stage, the number of positive cores, international society of urological pathology (ISUP) grade (biopsy), MRI lesion location, extracapsular extension, seminal vesicle invasion (SVI), pseudo-capsule invasion (PCI), long diameter of lesions, lesion volume, lesion volume ratio, PSA density were related to PSM. MRI lesion location and PCI were independent risk factors for PSM. Least absolute shrinkage and selection operator (LASSO) regression was used to construct a clinical prediction model for PSM, including five variables: the number of positive cores, SVI, MRI lesion location, long diameter of lesions, and PSA.

Conclusion

The positive rate of surgical margin in middle PZ was significantly lower than that in other regions, and MRI lesion location was an independent risk factor for PSM.

中文翻译：

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基于MRI病灶定位的腹腔镜前列腺癌根治术临床风险预测模型及阳性手术切缘外部验证

客观的

明确腹腔镜前列腺癌根治术后阳性手术切缘（PSM）不同磁共振成像（MRI）分区的病灶构成，探讨病灶位置对PSM的影响，构建临床预测模型来预测PSM的风险。

材料和方法

这项回顾性队列研究纳入了 2018 年至 2021 年在我中心接受腹腔镜根治性前列腺切除术的 309 例患者。2022 年 1 月至 9 月期间符合相同标准的 129 名患者为外部验证队列。

结果

过渡区（TZ）病变中PSM的发生率高于周围区（PZ）病变。中部PZ的PSM发病率低于其他地区。前列腺特异性抗原（PSA）、临床T分期、阳性核心数、国际泌尿病理学会（ISUP）分级（活检）、MRI病变部位、囊外扩展、精囊侵犯（SVI）、假包膜侵犯（ PCI）、病灶长径、病灶体积、病灶体积比、PSA密度与PSM相关。MRI病变位置和PCI是PSM的独立危险因素。采用最小绝对收缩和选择算子（LASSO）回归构建PSM的临床预测模型，包括阳性核心数、SVI、MRI病灶位置、病灶长径和PSA 5个变量。

结论

中部PZ手术切缘阳性率显着低于其他区域，MRI病灶位置是PSM的独立危险因素。