Open retropubic radical prostatectomy: Still a well-established surgical technique for prostate cancer management | Actas Urológicas Españolas (English Edition)

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(A and B) Difference in high and low pain at cystoscopy (A) or cauterization (B) with respect to demographics (age, gender), clinical parameters (number of cystoscopy, number of cauterization) and cystoscopy. (C) Difference in anxiety, and pain during cystoscopy or cauterization based on age. Age was divided as <66 or ≥66 (median age group). (D) Difference in pain during cystoscopy or cauterization based on anxiety." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S.D. Lokeshwar, S.N. Rahman, A. Choksi, B.H. Press, D. Shaheen, M.S. Soloway" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S.D." "apellidos" => "Lokeshwar" ] 1 => array:2 [ "nombre" => "S.N." "apellidos" => "Rahman" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Choksi" ] 3 => array:2 [ "nombre" => "B.H." "apellidos" => "Press" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Shaheen" ] 5 => array:2 [ "nombre" => "M.S." 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Stankovic, L. Wolff, T. Wieder, J. Mendes, B. Schumacher, M. Barro-Bejarano, C. Weber" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Stankovic" "email" => array:1 [ 0 => "mladen.stankovic@stadtmission-hd.de" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Wolff" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Wieder" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Mendes" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Schumacher" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Barro-Bejarano" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Weber" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Urology, Salem Hospital, Academic Hospital - University of Heidelberg, Heidelberg, Germany" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La prostatectomía radical retropúbica abierta es todavía una técnica quirúrgica bien establecida para el tratamiento del cáncer de próstata" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2811 "Ancho" => 3333 "Tamanyo" => 406588 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier plots of pT stage, pN stage, Gleason score sum and surgical margin status on OS." ] ] ] "textoCompleto" => "IntroductionIn 1947, Millin described the first retropubic approach following earlier reports of the perineal approach by Hugh-Hampton-Young in 1905.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> At the beginning, both retropubic and perineal approaches for radical prostatectomy were associated with significant intra- and post-operative morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a> In the last three decades however, technical modifications and refinements have considerably improved clinical and functional outcomes over time and have led to excellent long-term survival rates<a class="elsevierStyleCrossRefs" href="#bib0020">4–9</a> in patients undergoing ORP.<a class="elsevierStyleCrossRefs" href="#bib0015">3,10</a> One important factor is early detection, which was seen after introducing the prostate-specific antigen (PSA) screening. This has led to a dramatic downstage migration, favoring the detection of localized, organ confined disease,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> increasing the probability of organ confined disease on pathology, resulting in a higher demand for radical prostatectomy as the preferred treatment choice.<a class="elsevierStyleCrossRefs" href="#bib0005">1,12</a>The objective of this study is to examine the long-term oncological outcomes, biochemical recurrence (BCR)-free survival and overall survival (OS), to determine the complication rates and to examine the early continence rates in patients with prostate cancer treated with ORP at a single institution.Patients and methodsFrom January 2000 to December 2020, a total of 1181 patients diagnosed with prostate cancer underwent an open radical prostatectomy at our institution. Of these, 1142 underwent an open retropubic radical prostatectomy, salvage prostatectomies and patients treated with perineal approach were excluded. From these, 47 were further excluded due to incomplete follow-up data. Finally, 1095 patients were assessed. Patients with positive surgical margins but no extraprostatic extension (EPE) were considered to have organ-confined disease. The vast majority of patients (97.3%) had an obturator fossa lymph node dissection, regardless of their respective risk profile for having lymph node metastasis. The pathologist graded the tumors according to the Gleason system,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> analyzing the entire prostate including every tumor focus.All patients had a contrast cystography (7–10 days after the surgery) prior to removing the catheter, which was only then removed if there was no evidence of urinary leakage at the urethrovesical anastomosis. Upon catheter removal, patients had one day for pelvic floor muscle exercises. On the second day after catheter removal the early continence was examined using a standardized pad test, documented by residents. This test measures the amount of involuntary urine loss while performing predefined physical activities such as bending, coughing, climbing stairs and jumping with a full bladder (at least 150ml) within 1h. The urine pad was weighed before and after the test. Full continence was defined as urine loss of <10g and number of urine pads per day (one). Mild urinary incontinence grade I and grade II were defined as urine loss of 10−25g and 25−50g respectively. Urine loss of >50g represented severe incontinence. Number of pads per day determined late continence level around 1year after surgery. Patients who needed none or one pad per day were classified as continent. In order to ascertain the patient’s postoperative medical history including PSA nadir and follow-up PSA levels, time of BCR occurrence, choice of therapy in case of BCR and ultimately the time of death, if applicable, the patient and/or the referring urologist(s) were contacted. Patients who did not develop the event of interest were censored at their respective last day of contact. A PSA level above 0.2ng/ml, local recurrence or distant metastases was defined as biochemical recurrence. In the absence of BCR, the regular follow ups occurred according to current guidelines at the time. The BCR-free and OS rates were calculated using the Kaplan–Meier method. Subsequently, Kaplan–Meier curves graphically illustrate the effect of pT stage (pT2 vs pT3a vs pT3b vs pT4), pN stage (pN0 vs pN1 vs pNx), Gleason Score sum (≤6 vs 3+4 vs 4+3 vs ≥8), and of the surgical margin status (positive vs negative) on BCR-free and OS survival. Statistically significant differences between groups were assessed using the log-rank test. Finally, in order to identify independent predictors of BCR multivariable Cox-regression models were used. Tested predictor variables were age, preoperative PSA level, pT stage, pN stage, Gleason score sum and the surgical margin status. The significance level was set at 0.05. The complication rates were documented by using the Clavien Dindo classification.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The project was approved by the local ethics committee (F-2021-049). The statistics were performed by SPSS Software v23.Results<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> displays the relevant demographics and key endpoints. The median follow-up was 93,4 months. The median patient age at the time of ORP was 67,2 years. The median preoperative PSA level was 7,1ng/ml and the median PSA nadir was 0,04ng/ml. Overall, 649 (59.3%), 288 (26.3%), 142 (12.9%) and 14 (1.5%) patients had T2, T3a, T3b and T4 stage respectively. Most patients (90.1%) had no evidence of lymph node invasion, 7.3% had a positive lymph node status and 2,6% of patients did not undergo lymphadenectomy. The pathology Gleason score sums of the radical prostatectomy specimens were as follows: 163 patients (14.9%) had a Gleason score sum ≤6, 492 (44.9%) of 3+4, 265 (24.3%) of 4+3 and 175 (15.9%) of ≥8.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The differences in OS between pT2, pT3a and pT3b were statistically significant (p=0.0042), the difference between pT3b and pT4 was not (p=0.1) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In addition, the differences in OS between pN0, pNx and pN1 stage as for negative vs positive surgical margin status were statistically significant (p<0.001 and p=0.007 respectively). On the other hand, the differences in OS between patients with Gleason score sum ≤6, 3+4 and 4+3 were not statistically significant (p=0.44), but all three groups compared to Gleason score sum ≥8 were (p<0.001).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The 5- and 10-year BCR-free rates for all patients were 84% and 73% respectively. The OS rates for the same time points were 96% and 82% respectively (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The 10year BCR-free estimates according to pT stage were 84.6% for pT2 vs 77.8% for pT3a vs 51.4% for pT3b vs 43.8% for pT4 (p<0.001) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Comparisons according to pN stage showed 10year BCR-free survival of 80.2% for pN0 vs 48.8% for pN1 vs 79.3% for pNx (p<0.001) and the comparison according to Gleason score sum showed 10year BCR-free survival of 82.8% for ≤6 vs 82.1% for 3+4 vs 77.4% for 4+3 vs 62.3% for ≥8 (p<0.001). The 10year BCR-free survival estimates according to surgical margin status were 81.9% for R0 vs 70.3% for R1 (p<0.001). Of the 242 patients who developed a BCR, 224 (92.6%) received further therapies; 178 (73.5%) were treated with local radiotherapy and 46 (19.1%) with complete or intermittent ADT.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The PSA level was found to be a statistically significant predictor of BCR (hazard ratio 1.03; p<0.001). Furthermore, pT stage, pN stage, Gleason score sum and the surgical margin status were all independent predictors of BCR, as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>While the majority of patients (88.4%) did not have any deviation from the normal postoperative course, 4.8% of patients did develop complications classified as Clavien Dindo ≥3. Following continence rates were reported: 81.4% of patients were continent, 10.8% of patients had a mild incontinence grade I and 2.6% mild incontinence grade II. Nevertheless, 5.3% of patients had severe early incontinence. The late continence rate (10–14 months after the operation) was still very high with 89,1%.DiscussionIn the last few decades not only the diagnosis but also the treatment options for prostate cancer have changed significantly. During this time the surgical procedure of open radical prostatectomy was substantially modified<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> and is nowadays considered a safe procedure providing high cancer control rates with low morbidity.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The main goal of radical prostatectomy regardless of the approach remains the eradication of cancer while preserving pelvic organ function, whenever possible.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>At our institution 22% of the patients have developed biochemical recurrence. This is in accordance with previous findings of other studies, which reported rates of biochemical recurrences between 20% and 40% after undergoing curative treatment by ORP.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> The surgical approaches, which include laparoscopic and robotic-assisted prostatectomies, which have been used for more than 35 and 20 years respectively, were found to not significantly influence the probability of a biochemical recurrence.<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a> The surgeon’s experience, however, is strongly associated with biochemical recurrence after ORP independent of all preoperative risk categories.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> At our institution the vast majority of the operations were performed by a single surgeon, the chief of staff, who is also the most experienced surgeon in our team.Besides the experience of a surgeon, we found that pathologic features including extraprostatic extension, seminal vesicle involvement, lymph node involvement, Gleason score sum of the pathology specimen, and positive surgical margins were significant independent predictors of BCR in multivariate analysis. When BCR-free survival rates were stratified for stage, surgical margin and Gleason score sum, the best 10-year BCR-free survival rates were found in patients with organ confined disease (83%), Gleason score sum ≤6 (82%) and negative lymph node status (76%). These values and the overall 10-year BCR-free survival rate of 73%, were comparable to those found by other authors.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>As expected, the same was seen with the overall survival rates, with the best OS rates being in patients with organ confined disease (87%), with Gleason score sum ≤6 (86%) and negative lymph node status (82%). The overall 10-year survival of 82% was found.Surgical margins are associated with future biochemical recurrence and many studies use surgical margins as a surrogate for oncologic efficacy. Some single-institution studies reported positive surgical margin rates for ORP ranging from 33% to 36%,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> similar to our obtained results. We report a 10-year BCR-free survival rate of 79% for patients with negative surgical margins and an overall 10-year survival rate of 84%.Our study population had a very low incidence (4.8%) of major complications (Clavien Dindo ≥3), with the majority of patients (88.4%) not having any deviation from the normal postoperative course. The result is consistent with the current literature on complication rates after ORP.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Our findings further confirm and highlight the safety of the ORP while simultaneously providing high cancer control and low morbidity.Not only does ORP lead to good oncological outcomes, it also leads to good functional results, continence being one of them. For patients preserving continence constitutes one of the most important outcomes after prostatectomy. This is why it is almost always a primary endpoint in studies looking at prostatectomies. However, a consistent definition of continence seems to be lacking across the studies. Furthermore, the strategies and timing of determining continence rates seem to vary between the studies, making it hard to compare them.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Most studies seem to evaluate the continence at 12 months after surgery, and on average reported late continence rates of around 80%.<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> Our late continence rate (10–14 months after the operation) was very high with 891%. Our department is, to the best of our knowledge, one of the rare ones that have been using a standardized pad test routinely for the past 20 years. We found an early continence rate of 81.4%, which is, compared to some other small single center studies, with early continence rates ranging from 60 to 65%, considerably better.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> In addition, severe incontinence rates from our study were low with 5,3%, compared to rates published in the literature of around 15% on average.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>In some aspects the results of our study need to be interpreted considering its limitations; its single center design, retrospective character and missing clinical variables for pre- and postoperative erectile function. Also, the vast majority of surgeries was performed by a single surgeon, which may limit the external validity of the results. Despite these limitations, our study is one of a few from European countries to evaluate long-term oncological outcomes after ORP in the PSA era. All this considered, this study was not conducted to indicate the superiority of ORP over other therapies or surgical approaches, but to generate legitimate long-term data after ORP.ConclusionIn this retrospective, single center study, we found that ORP provides excellent long-term oncological outcomes, particularly in patients with clinically localized prostate cancer. ORP can be considered a safe surgical procedure that provides high early continence-rates." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1999094" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1713381" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1999095" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1713382" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-07-27" "fechaAceptado" => "2022-09-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1713381" "palabras" => array:6 [ 0 => "Biochemical recurrence" 1 => "Early continence" 2 => "Open radical prostatectomy" 3 => "Overall survival" 4 => "Pad test" 5 => "Prostate cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1713382" "palabras" => array:6 [ 0 => "Recidiva bioquímica" 1 => "Continencia precoz" 2 => "Prostatectomía radical abierta" 3 => "Supervivencia global" 4 => "Pad test" 5 => "Cáncer de próstata" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe surgical treatment options for prostate cancer have changed rapidly, given the expansion of robotics. However, open retropubic radical prostatectomy (ORP) will continue to be performed in areas with financial limitations or with limited access to robotics. The purpose of this study was to determine the long-term oncological outcomes, to categorize complication rates and to examine the early continence rates in patients treated with ORP. MethodsWe identified all patients who underwent ORP at our institution between 2000 and 2020. A standardized pad test was used to determine the early continence rates upon catheter removal, the late continence around a year after surgery was determined by the number of pads per day. The Clavien-Dindo classification was used to report the complication rates. The biochemical recurrence (BCR)-free survival and overall survival (OS) rates were defined using the Kaplan–Meier method and log-rank analysis. Multivariable Cox-regression models were used to test the effect of different factors on biochemical recurrence. ResultsWe analyzed 1095 patients. The median follow-up was 93.4 months. An overall 10-year BCR-free survival and OS of 73% and 82% respectively was found. A complication rate for Clavien Dindo≥3 was seen in 4.8% of patients. The early continence rate was 81.4% and the late continence 89,1%. Preoperative PSA level, Gleason score sum, pT stage, lymph node status, and surgical margin status were independent predictors of BCR (p<0.001, 95% CI). Limitations include retrospective and single center study design. ConclusionsORP is a surgical procedure that provides excellent oncological- and early continence-rates." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLas opciones de tratamiento quirúrgico del cáncer de próstata han experimentado cambios significativos gracias a la expansión de la robótica. Sin embargo, la prostatectomía radical retropúbica abierta (PRA) seguirá realizándose en aquellos entornos con limitaciones económicas o con escaso acceso a la robótica. El objetivo de este estudio fue determinar los resultados oncológicos a largo plazo, clasificar las tasas de complicaciones y examinar las tasas de recuperación temprana de la continencia en pacientes tratados con PRA. MétodosIdentificamos a todos los pacientes sometidos a PRA en nuestra institución entre 2000 y 2020. Se utilizó un pad test (prueba de la compresa) estandarizado para determinar las tasas de continencia precoz tras la retirada del catéter; la continencia tardía, alrededor de un año después de la cirugía, se determinó mediante el número de compresas por día. Se utilizó la clasificación de Clavien-Dindo para informar las tasas de complicaciones. Las tasas de supervivencia libre de recidiva bioquímica (RB) y de supervivencia global (SG) se definieron mediante el método de Kaplan–Meier y el análisis log-rank. Se utilizaron modelos multivariables de regresión de Cox para comprobar el efecto de los distintos factores sobre la recidiva bioquímica. ResultadosSe analizaron los datos de 1095 pacientes. La mediana de seguimiento fue de 93,4 meses. Se encontró una supervivencia global libre de RB a 10 años y una SG del 73% y del 82%, respectivamente. Se observó una tasa de complicaciones de Clavien Dindo≥3 en el 4,8% de los pacientes. La tasa de continencia precoz fue del 81,4% y la tasa de continencia tardía fue del 89,1%. El nivel de PSA preoperatorio, la suma de la puntuación de Gleason, el estadio pT, el estado de los ganglios linfáticos y el estado de los márgenes quirúrgicos fueron predictores independientes de RB (p<0,001, IC 95%). Entre las limitaciones del estudio están su diseño retrospectivo y unicéntrico. ConclusionesLa PRA es una intervención quirúrgica que proporciona excelentes tasas de control oncológico y de recuperación temprana de la continencia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2811 "Ancho" => 3333 "Tamanyo" => 406588 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier plots of pT stage, pN stage, Gleason score sum and surgical margin status on OS." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1111 "Ancho" => 3341 "Tamanyo" => 206362 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier plots for BCR-free and OS." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2748 "Ancho" => 3341 "Tamanyo" => 436751 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier plots of pT stage, pN stage, Gleason score sum and surgical margin status on BCR-free survival." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PSA — prostate specific antigen, BCR — biochemical reccurence, RP — radical prostatectomy, ADT — androgen deprivation therapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (median, range) or N (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.62 (67.21, 43.1−84.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative PSA, ng/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.1 (7.1, 0.18−127.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSA nadir, ng/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 (0.00, 0.00−7.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow up, months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.35 (93.40, 1−227) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">649 (59.27%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT3a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">288 (26.30%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT3b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142 (12.97%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (1.46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pN stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">986 (90.04%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 (7.31%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pNx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (2.65%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive surgical margins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Organ-confined \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">114 (10.41%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extraprostatic extension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">267 (24.38%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nerve sparing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">394 (35.98%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">701 (64.02%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RP Gleason score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">163 (14.89%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3+4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">492 (44.93%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4+3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">265 (24.20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">175 (15.98%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clavien Dindo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">absence of complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">968 (88.40%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 (6.76%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (1.46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (2.74%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (0.64%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of BCR patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">242 (22.10%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Management of BCR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">local radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">178 (73.55%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">complete or intermittent ADT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (19.01%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">further observation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (7.44%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3319367.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics and perioperative outcomes." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PSA — prostate specific antigen, RP — radical prostatectomy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR (95% CI), p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 (0.99−1.04), 0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSA level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 (1.01−1.03), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT3a vs pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.95 (1.42−2.67), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT3b va pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.11 (4.45−8.34), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT4 vs pT2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.61 (5.29−21.23), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pN stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pN1 vs pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.80 (2.44−13,77), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pNx vs pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.24 (0.55−2.08), 0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RP Gleason sum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3+4 vs ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 (0.49−1.17), 0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4+3 vs ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.51 (1.08−2.09), 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥8 vs ≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.39 (2.46−4.69), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgical margin status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive vs negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.08 (1.61−2.68), <0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3319366.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of multiple Cox-regression analyses predicting BCR." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of surgical techniques for radical prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Lepor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Urol" "fecha" => "2005" "volumen" => "7" "numero" => "Suppl 2" "paginaInicial" => "S11" "paginaFinal" => "S17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16985892" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The surgery of prostatic obstructions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. 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Open retropubic radical prostatectomy: Still a well-established surgical technique for prostate cancer management

La prostatectomía radical retropúbica abierta es todavía una técnica quirúrgica bien establecida para el tratamiento del cáncer de próstata

M. Stankovic

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mladen.stankovic@stadtmission-hd.de

Corresponding author.

, L. Wolff, T. Wieder, J. Mendes, B. Schumacher, M. Barro-Bejarano, C. Weber

Department of Urology, Salem Hospital, Academic Hospital - University of Heidelberg, Heidelberg, Germany

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        "titulo" => "La prostatectom&#237;a radical retrop&#250;bica abierta es todav&#237;a una t&#233;cnica quir&#250;rgica bien establecida para el tratamiento del c&#225;ncer de pr&#243;stata"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier plots of pT stage&#44; pN stage&#44; Gleason score sum and surgical margin status on OS&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 1947&#44; Millin described the first retropubic approach following earlier reports of the perineal approach by Hugh-Hampton-Young in 1905&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> At the beginning&#44; both retropubic and perineal approaches for radical prostatectomy were associated with significant intra- and post-operative morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> In the last three decades however&#44; technical modifications and refinements have considerably improved clinical and functional outcomes over time and have led to excellent long-term survival rates<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> in patients undergoing ORP&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a> One important factor is early detection&#44; which was seen after introducing the prostate-specific antigen &#40;PSA&#41; screening&#46; This has led to a dramatic downstage migration&#44; favoring the detection of localized&#44; organ confined disease&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> increasing the probability of organ confined disease on pathology&#44; resulting in a higher demand for radical prostatectomy as the preferred treatment choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this study is to examine the long-term oncological outcomes&#44; biochemical recurrence &#40;BCR&#41;-free survival and overall survival &#40;OS&#41;&#44; to determine the complication rates and to examine the early continence rates in patients with prostate cancer treated with ORP at a single institution&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">From January 2000 to December 2020&#44; a total of 1181 patients diagnosed with prostate cancer underwent an open radical prostatectomy at our institution&#46; Of these&#44; 1142 underwent an open retropubic radical prostatectomy&#44; salvage prostatectomies and patients treated with perineal approach were excluded&#46; From these&#44; 47 were further excluded due to incomplete follow-up data&#46; Finally&#44; 1095 patients were assessed&#46; Patients with positive surgical margins but no extraprostatic extension &#40;EPE&#41; were considered to have organ-confined disease&#46; The vast majority of patients &#40;97&#46;3&#37;&#41; had an obturator fossa lymph node dissection&#44; regardless of their respective risk profile for having lymph node metastasis&#46; The pathologist graded the tumors according to the Gleason system&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> analyzing the entire prostate including every tumor focus&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">All patients had a contrast cystography &#40;7&#8211;10 days after the surgery&#41; prior to removing the catheter&#44; which was only then removed if there was no evidence of urinary leakage at the urethrovesical anastomosis&#46; Upon catheter removal&#44; patients had one day for pelvic floor muscle exercises&#46; On the second day after catheter removal the early continence was examined using a standardized pad test&#44; documented by residents&#46; This test measures the amount of involuntary urine loss while performing predefined physical activities such as bending&#44; coughing&#44; climbing stairs and jumping with a full bladder &#40;at least 150<span class="elsevierStyleHsp" style=""></span>ml&#41; within 1<span class="elsevierStyleHsp" style=""></span>h&#46; The urine pad was weighed before and after the test&#46; Full continence was defined as urine loss of &#60;10<span class="elsevierStyleHsp" style=""></span>g and number of urine pads per day &#40;one&#41;&#46; Mild urinary incontinence grade I and grade II were defined as urine loss of 10&#8722;25<span class="elsevierStyleHsp" style=""></span>g and 25&#8722;50<span class="elsevierStyleHsp" style=""></span>g respectively&#46; Urine loss of &#62;50<span class="elsevierStyleHsp" style=""></span>g represented severe incontinence&#46; Number of pads per day determined late continence level around 1<span class="elsevierStyleHsp" style=""></span>year after surgery&#46; Patients who needed none or one pad per day were classified as continent&#46; In order to ascertain the patient&#8217;s postoperative medical history including PSA nadir and follow-up PSA levels&#44; time of BCR occurrence&#44; choice of therapy in case of BCR and ultimately the time of death&#44; if applicable&#44; the patient and&#47;or the referring urologist&#40;s&#41; were contacted&#46; Patients who did not develop the event of interest were censored at their respective last day of contact&#46; A PSA level above 0&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; local recurrence or distant metastases was defined as biochemical recurrence&#46; In the absence of BCR&#44; the regular follow ups occurred according to current guidelines at the time&#46; The BCR-free and OS rates were calculated using the Kaplan&#8211;Meier method&#46; Subsequently&#44; Kaplan&#8211;Meier curves graphically illustrate the effect of pT stage &#40;pT2 vs pT3a vs pT3b vs pT4&#41;&#44; pN stage &#40;pN0 vs pN1 vs pNx&#41;&#44; Gleason Score sum &#40;&#8804;6 vs 3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4 vs 4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 vs &#8805;8&#41;&#44; and of the surgical margin status &#40;positive vs negative&#41; on BCR-free and OS survival&#46; Statistically significant differences between groups were assessed using the log-rank test&#46; Finally&#44; in order to identify independent predictors of BCR multivariable Cox-regression models were used&#46; Tested predictor variables were age&#44; preoperative PSA level&#44; pT stage&#44; pN stage&#44; Gleason score sum and the surgical margin status&#46; The significance level was set at 0&#46;05&#46; The complication rates were documented by using the Clavien Dindo classification&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The project was approved by the local ethics committee &#40;F-2021-049&#41;&#46; The statistics were performed by SPSS Software v23&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> displays the relevant demographics and key endpoints&#46; The median follow-up was 93&#44;4 months&#46; The median patient age at the time of ORP was 67&#44;2 years&#46; The median preoperative PSA level was 7&#44;1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml and the median PSA nadir was 0&#44;04<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; Overall&#44; 649 &#40;59&#46;3&#37;&#41;&#44; 288 &#40;26&#46;3&#37;&#41;&#44; 142 &#40;12&#46;9&#37;&#41; and 14 &#40;1&#46;5&#37;&#41; patients had T2&#44; T3a&#44; T3b and T4 stage respectively&#46; Most patients &#40;90&#46;1&#37;&#41; had no evidence of lymph node invasion&#44; 7&#46;3&#37; had a positive lymph node status and 2&#44;6&#37; of patients did not undergo lymphadenectomy&#46; The pathology Gleason score sums of the radical prostatectomy specimens were as follows&#58; 163 patients &#40;14&#46;9&#37;&#41; had a Gleason score sum &#8804;6&#44; 492 &#40;44&#46;9&#37;&#41; of 3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4&#44; 265 &#40;24&#46;3&#37;&#41; of 4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 and 175 &#40;15&#46;9&#37;&#41; of &#8805;8&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The differences in OS between pT2&#44; pT3a and pT3b were statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0042&#41;&#44; the difference between pT3b and pT4 was not &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In addition&#44; the differences in OS between pN0&#44; pNx and pN1 stage as for negative vs positive surgical margin status were statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007 respectively&#41;&#46; On the other hand&#44; the differences in OS between patients with Gleason score sum &#8804;6&#44; 3&#43;4 and 4&#43;3 were not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;44&#41;&#44; but all three groups compared to Gleason score sum &#8805;8 were &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The 5- and 10-year BCR-free rates for all patients were 84&#37; and 73&#37; respectively&#46; The OS rates for the same time points were 96&#37; and 82&#37; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The 10<span class="elsevierStyleHsp" style=""></span>year BCR-free estimates according to pT stage were 84&#46;6&#37; for pT2 vs 77&#46;8&#37; for pT3a vs 51&#46;4&#37; for pT3b vs 43&#46;8&#37; for pT4 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Comparisons according to pN stage showed 10<span class="elsevierStyleHsp" style=""></span>year BCR-free survival of 80&#46;2&#37; for pN0 vs 48&#46;8&#37; for pN1 vs 79&#46;3&#37; for pNx &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and the comparison according to Gleason score sum showed 10<span class="elsevierStyleHsp" style=""></span>year BCR-free survival of 82&#46;8&#37; for &#8804;6 vs 82&#46;1&#37; for 3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4 vs 77&#46;4&#37; for 4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 vs 62&#46;3&#37; for &#8805;8 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The 10<span class="elsevierStyleHsp" style=""></span>year BCR-free survival estimates according to surgical margin status were 81&#46;9&#37; for R0 vs 70&#46;3&#37; for R1 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Of the 242 patients who developed a BCR&#44; 224 &#40;92&#46;6&#37;&#41; received further therapies&#59; 178 &#40;73&#46;5&#37;&#41; were treated with local radiotherapy and 46 &#40;19&#46;1&#37;&#41; with complete or intermittent ADT&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The PSA level was found to be a statistically significant predictor of BCR &#40;hazard ratio 1&#46;03&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Furthermore&#44; pT stage&#44; pN stage&#44; Gleason score sum and the surgical margin status were all independent predictors of BCR&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">While the majority of patients &#40;88&#46;4&#37;&#41; did not have any deviation from the normal postoperative course&#44; 4&#46;8&#37; of patients did develop complications classified as Clavien Dindo &#8805;3&#46; Following continence rates were reported&#58; 81&#46;4&#37; of patients were continent&#44; 10&#46;8&#37; of patients had a mild incontinence grade I and 2&#46;6&#37; mild incontinence grade II&#46; Nevertheless&#44; 5&#46;3&#37; of patients had severe early incontinence&#46; The late continence rate &#40;10&#8211;14 months after the operation&#41; was still very high with 89&#44;1&#37;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">In the last few decades not only the diagnosis but also the treatment options for prostate cancer have changed significantly&#46; During this time the surgical procedure of open radical prostatectomy was substantially modified<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> and is nowadays considered a safe procedure providing high cancer control rates with low morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The main goal of radical prostatectomy regardless of the approach remains the eradication of cancer while preserving pelvic organ function&#44; whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">At our institution 22&#37; of the patients have developed biochemical recurrence&#46; This is in accordance with previous findings of other studies&#44; which reported rates of biochemical recurrences between 20&#37; and 40&#37; after undergoing curative treatment by ORP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The surgical approaches&#44; which include laparoscopic and robotic-assisted prostatectomies&#44; which have been used for more than 35 and 20 years respectively&#44; were found to not significantly influence the probability of a biochemical recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> The surgeon&#8217;s experience&#44; however&#44; is strongly associated with biochemical recurrence after ORP independent of all preoperative risk categories&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> At our institution the vast majority of the operations were performed by a single surgeon&#44; the chief of staff&#44; who is also the most experienced surgeon in our team&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Besides the experience of a surgeon&#44; we found that pathologic features including extraprostatic extension&#44; seminal vesicle involvement&#44; lymph node involvement&#44; Gleason score sum of the pathology specimen&#44; and positive surgical margins were significant independent predictors of BCR in multivariate analysis&#46; When BCR-free survival rates were stratified for stage&#44; surgical margin and Gleason score sum&#44; the best 10-year BCR-free survival rates were found in patients with organ confined disease &#40;83&#37;&#41;&#44; Gleason score sum &#8804;6 &#40;82&#37;&#41; and negative lymph node status &#40;76&#37;&#41;&#46; These values and the overall 10-year BCR-free survival rate of 73&#37;&#44; were comparable to those found by other authors&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">As expected&#44; the same was seen with the overall survival rates&#44; with the best OS rates being in patients with organ confined disease &#40;87&#37;&#41;&#44; with Gleason score sum &#8804;6 &#40;86&#37;&#41; and negative lymph node status &#40;82&#37;&#41;&#46; The overall 10-year survival of 82&#37; was found&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Surgical margins are associated with future biochemical recurrence and many studies use surgical margins as a surrogate for oncologic efficacy&#46; Some single-institution studies reported positive surgical margin rates for ORP ranging from 33&#37; to 36&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> similar to our obtained results&#46; We report a 10-year BCR-free survival rate of 79&#37; for patients with negative surgical margins and an overall 10-year survival rate of 84&#37;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Our study population had a very low incidence &#40;4&#46;8&#37;&#41; of major complications &#40;Clavien Dindo &#8805;3&#41;&#44; with the majority of patients &#40;88&#46;4&#37;&#41; not having any deviation from the normal postoperative course&#46; The result is consistent with the current literature on complication rates after ORP&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Our findings further confirm and highlight the safety of the ORP while simultaneously providing high cancer control and low morbidity&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Not only does ORP lead to good oncological outcomes&#44; it also leads to good functional results&#44; continence being one of them&#46; For patients preserving continence constitutes one of the most important outcomes after prostatectomy&#46; This is why it is almost always a primary endpoint in studies looking at prostatectomies&#46; However&#44; a consistent definition of continence seems to be lacking across the studies&#46; Furthermore&#44; the strategies and timing of determining continence rates seem to vary between the studies&#44; making it hard to compare them&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Most studies seem to evaluate the continence at 12 months after surgery&#44; and on average reported late continence rates of around 80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> Our late continence rate &#40;10&#8211;14 months after the operation&#41; was very high with 891&#37;&#46; Our department is&#44; to the best of our knowledge&#44; one of the rare ones that have been using a standardized pad test routinely for the past 20 years&#46; We found an early continence rate of 81&#46;4&#37;&#44; which is&#44; compared to some other small single center studies&#44; with early continence rates ranging from 60 to 65&#37;&#44; considerably better&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In addition&#44; severe incontinence rates from our study were low with 5&#44;3&#37;&#44; compared to rates published in the literature of around 15&#37; on average&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In some aspects the results of our study need to be interpreted considering its limitations&#59; its single center design&#44; retrospective character and missing clinical variables for pre- and postoperative erectile function&#46; Also&#44; the vast majority of surgeries was performed by a single surgeon&#44; which may limit the external validity of the results&#46; Despite these limitations&#44; our study is one of a few from European countries to evaluate long-term oncological outcomes after ORP in the PSA era&#46; All this considered&#44; this study was not conducted to indicate the superiority of ORP over other therapies or surgical approaches&#44; but to generate legitimate long-term data after ORP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">In this retrospective&#44; single center study&#44; we found that ORP provides excellent long-term oncological outcomes&#44; particularly in patients with clinically localized prostate cancer&#46; ORP can be considered a safe surgical procedure that provides high early continence-rates&#46;</p></span></span>"
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      "en" => array:3 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The surgical treatment options for prostate cancer have changed rapidly&#44; given the expansion of robotics&#46; However&#44; open retropubic radical prostatectomy &#40;ORP&#41; will continue to be performed in areas with financial limitations or with limited access to robotics&#46; The purpose of this study was to determine the long-term oncological outcomes&#44; to categorize complication rates and to examine the early continence rates in patients treated with ORP&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We identified all patients who underwent ORP at our institution between 2000 and 2020&#46; A standardized pad test was used to determine the early continence rates upon catheter removal&#44; the late continence around a year after surgery was determined by the number of pads per day&#46; The Clavien-Dindo classification was used to report the complication rates&#46; The biochemical recurrence &#40;BCR&#41;-free survival and overall survival &#40;OS&#41; rates were defined using the Kaplan&#8211;Meier method and log-rank analysis&#46; Multivariable Cox-regression models were used to test the effect of different factors on biochemical recurrence&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We analyzed 1095 patients&#46; The median follow-up was 93&#46;4 months&#46; An overall 10-year BCR-free survival and OS of 73&#37; and 82&#37; respectively was found&#46; A complication rate for Clavien Dindo&#8805;3 was seen in 4&#46;8&#37; of patients&#46; The early continence rate was 81&#46;4&#37; and the late continence 89&#44;1&#37;&#46; Preoperative PSA level&#44; Gleason score sum&#44; pT stage&#44; lymph node status&#44; and surgical margin status were independent predictors of BCR &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; 95&#37; CI&#41;&#46; Limitations include retrospective and single center study design&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ORP is a surgical procedure that provides excellent oncological- and early continence-rates&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Las opciones de tratamiento quir&#250;rgico del c&#225;ncer de pr&#243;stata han experimentado cambios significativos gracias a la expansi&#243;n de la rob&#243;tica&#46; Sin embargo&#44; la prostatectom&#237;a radical retrop&#250;bica abierta &#40;PRA&#41; seguir&#225; realiz&#225;ndose en aquellos entornos con limitaciones econ&#243;micas o con escaso acceso a la rob&#243;tica&#46; El objetivo de este estudio fue determinar los resultados oncol&#243;gicos a largo plazo&#44; clasificar las tasas de complicaciones y examinar las tasas de recuperaci&#243;n temprana de la continencia en pacientes tratados con PRA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Identificamos a todos los pacientes sometidos a PRA en nuestra instituci&#243;n entre 2000 y 2020&#46; Se utiliz&#243; un pad test &#40;prueba de la compresa&#41; estandarizado para determinar las tasas de continencia precoz tras la retirada del cat&#233;ter&#59; la continencia tard&#237;a&#44; alrededor de un a&#241;o despu&#233;s de la cirug&#237;a&#44; se determin&#243; mediante el n&#250;mero de compresas por d&#237;a&#46; Se utiliz&#243; la clasificaci&#243;n de Clavien-Dindo para informar las tasas de complicaciones&#46; Las tasas de supervivencia libre de recidiva bioqu&#237;mica &#40;RB&#41; y de supervivencia global &#40;SG&#41; se definieron mediante el m&#233;todo de Kaplan&#8211;Meier y el an&#225;lisis log-rank&#46; Se utilizaron modelos multivariables de regresi&#243;n de Cox para comprobar el efecto de los distintos factores sobre la recidiva bioqu&#237;mica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se analizaron los datos de 1095 pacientes&#46; La mediana de seguimiento fue de 93&#44;4 meses&#46; Se encontr&#243; una supervivencia global libre de RB a 10 a&#241;os y una SG del 73&#37; y del 82&#37;&#44; respectivamente&#46; Se observ&#243; una tasa de complicaciones de Clavien Dindo<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3 en el 4&#44;8&#37; de los pacientes&#46; La tasa de continencia precoz fue del 81&#44;4&#37; y la tasa de continencia tard&#237;a fue del 89&#44;1&#37;&#46; El nivel de PSA preoperatorio&#44; la suma de la puntuaci&#243;n de Gleason&#44; el estadio pT&#44; el estado de los ganglios linf&#225;ticos y el estado de los m&#225;rgenes quir&#250;rgicos fueron predictores independientes de RB &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; IC 95&#37;&#41;&#46; Entre las limitaciones del estudio est&#225;n su dise&#241;o retrospectivo y unic&#233;ntrico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La PRA es una intervenci&#243;n quir&#250;rgica que proporciona excelentes tasas de control oncol&#243;gico y de recuperaci&#243;n temprana de la continencia&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier plots of pT stage&#44; pN stage&#44; Gleason score sum and surgical margin status on OS&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier plots for BCR-free and OS&#46;</p>"
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier plots of pT stage&#44; pN stage&#44; Gleason score sum and surgical margin status on BCR-free survival&#46;</p>"
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      3 => array:8 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">PSA &#8212; prostate specific antigen&#44; BCR &#8212; biochemical reccurence&#44; RP &#8212; radical prostatectomy&#44; ADT &#8212; androgen deprivation therapy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;median&#44; range&#41; or N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;62 &#40;67&#46;21&#44; 43&#46;1&#8722;84&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preoperative PSA&#44; ng&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;1 &#40;7&#46;1&#44; 0&#46;18&#8722;127&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSA nadir&#44; ng&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04 &#40;0&#46;00&#44; 0&#46;00&#8722;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow up&#44; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;35 &#40;93&#46;40&#44; 1&#8722;227&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">649 &#40;59&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">288 &#40;26&#46;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;12&#46;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;1&#46;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pN stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pN0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">986 &#40;90&#46;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pN1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;7&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pNx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;2&#46;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive surgical margins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Organ-confined&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;10&#46;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extraprostatic extension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267 &#40;24&#46;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nerve sparing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">394 &#40;35&#46;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">701 &#40;64&#46;02&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RP Gleason score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;14&#46;89&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">492 &#40;44&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">265 &#40;24&#46;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175 &#40;15&#46;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clavien Dindo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>absence of complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">968 &#40;88&#46;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;6&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;1&#46;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;2&#46;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;0&#46;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of BCR patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;22&#46;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Management of BCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>local radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;73&#46;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>complete or intermittent ADT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;19&#46;01&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>further observation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;7&#46;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR &#40;95&#37; CI&#41;&#44; <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02 &#40;0&#46;99&#8722;1&#46;04&#41;&#44; 0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSA level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02 &#40;1&#46;01&#8722;1&#46;03&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3a vs pT2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;95 &#40;1&#46;42&#8722;2&#46;67&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT3b va pT2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;11 &#40;4&#46;45&#8722;8&#46;34&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pT4 vs pT2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;61 &#40;5&#46;29&#8722;21&#46;23&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pN stage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pN1 vs pN0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;80 &#40;2&#46;44&#8722;13&#44;77&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>pNx vs pN0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;24 &#40;0&#46;55&#8722;2&#46;08&#41;&#44; 0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RP Gleason sum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>4 vs &#8804;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;76 &#40;0&#46;49&#8722;1&#46;17&#41;&#44; 0&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 vs &#8804;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;51 &#40;1&#46;08&#8722;2&#46;09&#41;&#44; 0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;8 vs &#8804;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;39 &#40;2&#46;46&#8722;4&#46;69&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical margin status&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive vs negative&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;08 &#40;1&#46;61&#8722;2&#46;68&#41;&#44; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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