title: Safe-R: a novel score, accounting for oncological safe nerve-sparing at radical prostatectomy for localized prostate cancer.
abstract: OBJECTIVE
  The objectives of the study were to describe a novel score (safe-R), combining information on surgical margin status (SM) and extend of nerve-sparing (NS) applicable for all patients undergoing radical prostatectomy (RP), and to test the impact of our frozen-section navigated nerve-sparing approach (NeuroSAFE) on safe-R score.
  
  
  METHODS
  We retrospectively analyzed 9,635 RPs performed at our center between 2002 and 2011. Of these, 47 % were conducted with NeuroSAFE. Proportions of NS and SM status were assessed. Subsequently, a score for oncological safe NS (safe-R) was developed; Safe-R was categorized as 3 (for negative SM and bilateral NS), 2 (for negative SM and unilateral NS), 1 (for negative SM without NS), and 0 (for patients with positive SM), respectively. The impact of NeuroSAFE on safe-R was analyzed by chi-square test and confirmed by multinomial logistic regression, adjusting for preoperative risk factors.
  
  
  RESULTS
  Applying NeuroSAFE resulted in enhanced safe-R score, indicating lower rates of positive SM and higher rates of NS, across all risk categories (all p < 0.001). For example in high-risk patients, NeuroSAFE resulted in lower proportions of safe-R 0 (27.6 vs. 33.6 %) and higher proportions of safe-R 3 (32.4 vs. 17.1 %, p < 0.001). Linkage between the NeuroSAFE approach and safe-R was confirmed after multinomial logistic adjustment for preoperative risk factors. All results were confirmed in a propensity-matched cohort (matched for preoperative risk factors and year of surgery, data not shown).
  
  
  CONCLUSIONS
  Safe-R represents a novel tool to assess and report on oncological safe nerve-sparing in RP. NeuroSAFE is associated with enhanced safe-R scores.
authors.affiliation: Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, a.becker@uke.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Carolina
authors.initials: C
authors.lastname: Coelius
authors.forename: Meike
authors.initials: M
authors.lastname: Adam
authors.forename: Pierre
authors.initials: P
authors.lastname: Tennstedt
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Uwe
authors.initials: U
authors.lastname: Michl
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005629:Frozen Sections; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome