Learning Curve of an Innovative "3-Port" Laparoscopic Radical Prostatectomy: A Single-Center Analysis from 2016 to 2019.

BACKGROUND: "Three-port" laparoscopic radical prostatectomy (LRP) has been applied as a substitution for the conventional 4- to 5-port LRP to treat prostate cancer (PCa) patients in our institution. OBJECTIVE: To evaluate the learning curve of an innovative "3-port" LRP for PCa patients. METHODS: 206 patients who received "3-port" LRP were retrospectively reviewed between January 2016 and December 2019 at our institution. According to the different years of operations performed, all of the patients were divided into group A (No. 1-50), group B (No. 51-107), group C (No. 108-160), and group D (No. 161-206). A learning curve was depicted by analyzing the parameters of operative time (OT), estimated blood loss (EBL), hospitalization, and drainage indwelling days. RESULTS: All groups were comparable with regard to the preoperative characteristics (p > 0.05). The sloping learning curve for the surgeon showed that OT and EBL were strongly correlated with an accumulated experience when compared between group A and the other groups (p < 0.05), denoting that the surgical skill of the "3-port" LRP can be fully mastered after around 50 cases. Although no significant correlation with additional experience was observed in the hospitalization and drainage indwelling days among groups, a tendency towards less hospitalization and drainage indwelling days was still reflected. CONCLUSIONS: Our 4-year analysis based on a single-center experience exhibits that the innovative "3-port" LRP appears to be favorable with decreasing tendency in OT and EBL with experience accumulation. In view of its advantage of perioperative parameters with an evidently improved learning curve, it should be recommended in the clinical practice!

Aberrant methylation of the 16q23.1 tumor suppressor gene ADAMTS18 promotes tumorigenesis and progression of clear cell renal cell carcinoma.

BACKGROUND: The 16q23.1 tumor suppressor gene (TSG) of ADAMTS18 has been identified to be aberrant methylated in clear cell renal cell carcinoma (ccRCC), and there still exists an unclear situation between its methylation and the progression of ccRCC. OBJECTIVE: To analyze the biological function and mechanism of ADAMTS18 gene in the tumorigenesis and progression of ccRCC. METHODS: We examined ADAMTS18 gene methylation using methylation- specific polymerase chain reaction (MSP) in 92 ccRCC primary tumors from September 2017 to May 2018. Using reverse transcriptase PCR (RT-PCR) and immunohistochemical (IHC) assay, the relative expression level of ADAMTS18 was measured in the representative tumor samples with their adjacent normal tissues. Meanwhile, colony formation, cell viability, wound healing, transwell chamber, flow cytometry, and PI staining were performed to confirm the tumor-suppressive function and mechanism of ADAMTS18 gene. RESULTS: Aberrant methylation was further detected in 47 of the 92 (51.1%) primary tumors and in 8 of the 92 (8.7%) adjacent normal tissues (p < 0.05). Due to the phenomenon of aberrant methylation, ectopic low-level expression of ADAMTS18 gene could result in the promotion of tumorigenesis and progression in ccRCC. CONCLUSION: The aberrantly methylated ADAMTS18 gene may be involved in the tumorigenesis and progression of ccRCC.

Short-term benefit of neoadjuvant hormone therapy in patients with localized high-risk or limited progressive prostate cancer.

Purpose: Radical surgery is the preferred method for local high-risk and limited progressive prostate cancer in the routine clinical setting. However, current guidelines do not recommend neoadjuvant hormone therapy (NHT). Opinions regarding NHT vary among individual clinicians. According to the experience gained at our center, we explored the benefits of NHT for patients with prostate cancer during the perioperative period in this study. Methods: In this retrospective study, we explored the perioperative benefits of NHT among 189 patients with local high-risk or limited progressive prostate cancer who underwent radical prostatectomy and divided them into two groups: the NHT group and the non-NHT group. The NHT regimens were a gonadotropin-releasing hormone (GnRH) agonist alone (3.75/11.25 mg of leuprolide or 3.6/10.8 mg of goserelin acetate), an androgen receptor antagonist (ARA) alone, or a combination of the two. The duration of treatment was <3 months, 3 to 6 months, or >6 months. Results: We found that NHT could reduce the surgery time and intraoperative hemorrhage, thus reducing the difficulty of surgery; NHT could also improve the postoperative recovery of patients. However, it did not reduce the stage of prostate cancer or positive surgical margin rate. Conclusions: Neoadjuvant therapy is optional for some patients. We believe that NHT will improve the overall prognosis of patients as progress continues in the medical field in the future.

Preoperative PROSTATE scoring system: a potential predictive tool for the risk of biochemical recurrence after radical prostatectomy.

PURPOSE: To study the association between the preoperative PROSTATE scoring system and the prediction of biochemical recurrence (BCR) risk, after radical prostatectomy (RP) in prostate cancer patients. PATIENTS AND METHODS: A total of 340 patients who underwent a laparoscopic radical prostatectomy in Peking University First Hospital between November 2007 and March 2016 were included in the study. The preoperative PROSTATE scoring system was measured and calculated. The performance of the scoring system to predict BCR risk was estimated using the receiver operating characteristic curve (ROC curve). BCR-free survival was analyzed using the Kaplan- Meier method, and the log-rank test was applied to compare the differences in risk among the patient groups. The Cox proportional hazards regression was used to analyze the performance of the grouped PROSTATE scores. RESULTS: Of the total population, 91 (26.8%) patients had BCR. The PROSTATE score was significantly different between the BCR-developed and BCR-free groups (P<0.001). The ROC curve analysis of the scoring system showed an accuracy of 70.7% (95% CI 0.643-0.771) (P<0.001). The percentage of BCR in the high-risk (10-15), moderate-risk (5-9) and low-risk (0-4) groups was 63.3%, 24.6% and 10.3% respectively (P<0.001). The Cox proportional hazards regression analysis revealed that the grouped score was an independent predictor of BCR after RP (HR=2.002; 95% CI 1.222-3.280) (P=0.006). CONCLUSION: The PROSTATE scoring system performed adequately in predicting the risk of BCR after RP. The scoring system can assist in decision-making about the operation and post- operative follow-up for patients with high-risk.

The Institute of Urology, Peking University prostatectomy score: a simple preoperative classification of prostate cancer for predicting surgical difficulty and risk.

Traditional laparoscopic radical prostatectomy is a treatment choice in many developing countries and regions for most patients with localized prostate cancer; however, no system for predicting surgical difficulty and risk has been established. This study aimed to propose a simple and standard preoperative classification system of prostate cancer using preoperative data to predict surgical difficulty and risk and to evaluate the relationship between the data and postoperative complications. We collected data from 236 patients and divided them into three groups to evaluate and validate the relationships among preoperative, operative, and postoperative data. This new scoring system is based on the body mass index, ultrasonic prostate volume, preoperative prostate-specific antigen level, middle lobe protrusion, and clinical stage. In the scoring group, we classified 89 patients into two groups: the low-risk group (score of <4) and high-risk group (score of ≥4), and then compared the postoperative data between the two groups. The positive surgical margin rate was higher in the high-risk group than low-risk group. The results in validation Groups A and B were similar to those in the scoring group. The focus of our scoring system is to allow for preliminary assessment of surgical difficulty by collecting the patients' basic information. Urologists can easily use the scoring system to evaluate the surgical difficulty and predict the risks of a positive surgical margin and urinary incontinence in patients undergoing laparoscopic radical prostatectomy.