机器人辅助根治性前列腺切除术后的生化复发：1384 例患者的 5 年中位随访分析。
Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up.
机构信息
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
出版信息
Eur Urol. 2010 Dec;58(6):838-46. doi: 10.1016/j.eururo.2010.09.010. Epub 2010 Sep 17.
BACKGROUND
There is a paucity of data on long-term oncologic outcomes for patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa).
OBJECTIVE
To evaluate oncologic outcomes in patients undergoing RARP at a high-volume tertiary center, with a focus on 5-yr biochemical recurrence-free survival (BCRFS).
DESIGN, SETTING, AND PARTICIPANTS: The study cohort consisted of 1384 consecutive patients with localized PCa who underwent RARP between September 2001 and May 2005 and had a median follow-up of 60.2 mo. No patient had secondary therapy until documented biochemical recurrence (BCR). BCR was defined as a serum prostate-specific antigen ≥ 0.2 ng/ml with a confirmatory value. BCRFS was estimated using the Kaplan-Meier method. Event-time distributions for the time to failure were compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of BCR.
INTERVENTION
All patients underwent RARP.
MEASUREMENTS
BCRFS rates were measured.
RESULTS AND LIMITATIONS
This cohort of patients had moderately aggressive PCa: 49.0% were D'Amico intermediate or high risk on biopsy; however, 60.9% had Gleason 7-10 disease, and 25.5% had ≥ T3 disease on final pathology. There were 189 incidences of BCR (31 per 1,000 person years of follow-up) at a median follow-up of 60.2 mo (interquartile range [IQR]: 37.2-69.7). The actuarial BCRFS was 95.1%, 90.6%, 86.6%, and 81.0% at 1, 3, 5, and 7 yr, respectively. In the patients who recurred, median time to BCR was 20.4 mo; 65% of BCR incidences occurred within 3 yr and 86.2% within 5 yr. On multivariable analysis, the strongest predictors of BCR were pathologic Gleason grade 8-10 (hazard ratio [HR]: 5.37; 95% confidence interval [CI], 2.99-9.65; p < 0.0001) and pathologic stage T3b/T4 (HR: 2.71; 95% CI, 1.67-4.40; p < 0.0001).
CONCLUSIONS
In a contemporary cohort of patients with localized PCa, RARP confers effective 5-yr biochemical control.
背景
目前针对接受机器人辅助根治性前列腺切除术（RARP）治疗前列腺癌（PCa）患者的长期肿瘤学结果数据较为缺乏。
目的
评估高容量三级中心患者接受 RARP 的肿瘤学结果，重点关注 5 年生化无复发生存率（BCRFS）。
设计、设置和参与者：研究队列包括 1384 例接受 RARP 的局限性 PCa 连续患者，手术时间为 2001 年 9 月至 2005 年 5 月，中位随访时间为 60.2 个月。直到有记录的生化复发（BCR）之前，没有患者接受辅助治疗。BCR 定义为血清前列腺特异性抗原≥0.2ng/ml，且具有确认值。使用 Kaplan-Meier 法估计 BCRFS。使用对数秩检验比较失败时间的事件分布。使用单变量和多变量 Cox 比例风险回归模型确定预测 BCR 的变量。
干预
所有患者均接受 RARP。
测量
测量 BCRFS 率。
结果和局限性
该患者队列的 PCa 侵袭性中等：49.0%的患者在活检时为 D'Amico 中高危；然而，60.9%的患者有 Gleason 7-10 级疾病，25.5%的患者在最终病理上有≥T3 级疾病。在中位随访 60.2 个月（四分位距[IQR]：37.2-69.7）时，有 189 例 BCR（31/1000 人年）。 actuarial BCRFS 在 1、3、5 和 7 年时分别为 95.1%、90.6%、86.6%和 81.0%。在复发的患者中，BCR 的中位时间为 20.4 个月；65%的 BCR 发生率发生在 3 年内，86.2%发生在 5 年内。多变量分析显示，BCR 的最强预测因素是病理 Gleason 分级 8-10（风险比[HR]：5.37；95%置信区间[CI]：2.99-9.65；p<0.0001）和病理分期 T3b/T4（HR：2.71；95%CI：1.67-4.40；p<0.0001）。
结论
在当代局限性 PCa 患者队列中，RARP 可有效控制 5 年生化复发。
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