Busch Jonas, Gonzalgo Mark L, Leva Natalia, Ferrari Michelle, Cash Hannes, Kempkensteffen Carsten, Hinz Stefan, Miller Kurt, Magheli Ahmed
Department of Urology, Charité University Medicine Berlin, Berlin, Germany,
World J Urol. 2015 Mar;33(3):397-402. doi: 10.1007/s00345-014-1326-1. Epub 2014 May 23.
To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.
A total of 869 patients with body mass index ≥ 30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.
Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.
RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.
由于关于肿瘤学和生存结果的比较数据有限，本研究旨在调查接受机器人辅助根治性前列腺切除术（RARP）的肥胖患者与腹腔镜根治性前列腺切除术（LRP）或开放耻骨后根治性前列腺切除术（RRP）相比的病理和肿瘤学结果。
从两个学术中心共识别出869例体重指数≥30的患者。194例行RARP的患者按倾向评分（PS）1:1与LRP或RRP病例匹配。PS匹配变量包括前列腺特异性抗原（PSA）、活检Gleason评分、临床分期、外科医生经验和保留神经技术。使用逻辑回归分析手术切缘阳性（PSM）的预测因素。在Cox回归模型中分析无复发生存期（RFS）的预测因素。使用对数秩检验比较总生存期和RFS。
病理Gleason评分<7、=7和>7的患者分别占24.2%、63.6%和11.7%。手术技术之间在病理分期或淋巴结转移方面无统计学显著差异。pT2疾病的PSM在接受RARP、LRP和RRP的患者中分别为22.9%、17.4%和19.3%（无显著差异）。术前PSA和临床分期cT2疾病与PSM独立相关。RARP、LRP和RRP的平均3年RFS无显著差异（87.4%、91.0%和85.7%）。活检Gleason评分>7、PSM和临床分期二期是RFS降低的独立预测因素。
对于肥胖患者，RARP与LRP或RRP相比显示出相似的病理和肿瘤学结果。
