Tseng Timothy Y, Cancel Quinton V, Fesperman Susan F, Kuebler Hubert R, Sun Leon, Robertson Cary N, Polascik Thomas J, Moul Judd W, Vieweg Johannes, Albala David M, Dahm Philipp
Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA.
J Urol. 2007 Apr;177(4):1318-23. doi: 10.1016/j.juro.2006.11.035.
We determined the potential influence of an early adopter bias in patients undergoing robot assisted laparoscopic prostatectomy.
We compared baseline demographic, clinical and health related quality of life characteristics of patients undergoing 3 different surgical procedures for clinically localized prostate cancer following the introduction of robot assisted laparoscopic prostatectomy at our institution. Patients included in this analysis were participating in a prospective health related quality of life study using the SF-12(R) and Expanded Prostate Cancer Index Composite validated questionnaires.
Of 402 patients 159 (39%) underwent robot assisted laparoscopic, 144 (36%) underwent radical perineal and 99 (25%) underwent radical retropubic prostatectomy. There were no statistically significant associations between procedure type and patient age (p = 0.267), race (p = 0.725), number of medical comorbidities (p = 0.490), income (p = 0.056) and level of education (p = 0.495). Mean prostate specific antigen was 5.9 +/- 3.3, 7.3 +/- 5.5 and 5.7 +/- 5.0 ng/ml for robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy, respectively (p = 0.030). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with a final Gleason score of 4-6 was 55%, 45% and 39%, respectively (p = 0.037). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with stage T2 disease was 91%, 68% and 80%, respectively (p = 0.001). Statistically significant associations of higher income and education with higher baseline health related quality of life scores were seen in the sexual and physical domains (each p <0.01).
We failed to find evidence of an early adopter bias for patients undergoing robot assisted laparoscopic prostatectomy. Nevertheless, observational studies comparing robot assisted laparoscopic prostatectomy to radical perineal and radical retropubic prostatectomy should account carefully for patient baseline characteristics to allow meaningful comparisons of surgical outcomes.
我们确定了早期采用者偏倚对接受机器人辅助腹腔镜前列腺切除术患者的潜在影响。
在我们机构引入机器人辅助腹腔镜前列腺切除术后，我们比较了接受3种不同手术治疗临床局限性前列腺癌患者的基线人口统计学、临床和健康相关生活质量特征。纳入该分析的患者参与了一项使用SF-12(R)和经验证的前列腺癌指数综合扩展问卷的前瞻性健康相关生活质量研究。
402例患者中，159例（39%）接受了机器人辅助腹腔镜手术，144例（36%）接受了经会阴根治性手术，99例（25%）接受了耻骨后根治性前列腺切除术。手术类型与患者年龄（p = 0.267）、种族（p = 0.725）、合并症数量（p = 0.490）、收入（p = 0.056）和教育水平（p = 0.495）之间无统计学显著关联。机器人辅助腹腔镜、经会阴根治性和耻骨后根治性前列腺切除术患者的平均前列腺特异性抗原分别为5.9±3.3、7.3±5.5和5.7±5.0 ng/ml（p = 0.030）。最终Gleason评分为4 - 6分的机器人辅助腹腔镜、经会阴根治性和耻骨后根治性前列腺切除术患者比例分别为55%、45%和39%（p = 0.037）。处于T2期疾病的机器人辅助腹腔镜、经会阴根治性和耻骨后根治性前列腺切除术患者比例分别为91%、68%和80%（p = 0.001）。在性和身体领域，收入和教育水平较高与较高的基线健康相关生活质量得分之间存在统计学显著关联（均p <0.01）。
我们未能找到接受机器人辅助腹腔镜前列腺切除术患者存在早期采用者偏倚的证据。然而，比较机器人辅助腹腔镜前列腺切除术与经会阴根治性和耻骨后根治性前列腺切除术的观察性研究应仔细考虑患者基线特征，以便对手术结果进行有意义的比较。
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