Rush Stacy, Alibhai Shabbir M H, Xu Lizhen, Xu Wei, Louis Alyssa S, Matthew Andrew G, Nesbitt Michael, Finelli Antonio, Fleshner Neil E, Hamilton Robert J, Kulkarni Girish, Zlotta Alexandre, Jewett Michael A S, Trachtenberg John
Department of Surgery (Urology) and Oncology, Princess Margaret Cancer Centre, University Health Network and the Department of Surgery, University of Toronto, Toronto, ON;
Department of Medicine, University Health Network and the Department of Medicine, University of Toronto, Toronto, ON;
Can Urol Assoc J. 2015 May-Jun;9(5-6):179-87. doi: 10.5489/cuaj.2618.
It is unclear whether health-related quality of life (HRQoL) outcomes are superior in robot-assisted radical prostatectomy (RARP) compared to open prostatectomy (ORP).
We retrospectively analyzed records from men who received ORP or RARP at our institution between January 2009 and December 2012. Patients completed a demographics questionnaire and the Patient-Oriented Prostate Utility Scale (PORPUS), a validated disease-specific HRQoL instrument prior to surgery and every 3 months up to 15 months after surgery.
In total, 974 men met the inclusion criteria (643 ORP and 331 RARP patients). At baseline, RARP patients were significantly younger (p < 0.001), had lower body mass index (BMI) (p < 0.001), lower preoperative prostate-specific antigen (PSA) (p < 0.001), fewer comorbidities (p < 0.004), and higher baseline PORPUS scores (p = 0.024). On follow-up, unadjusted PORPUS scores were significantly higher in the RARP group at each point. On multivariable analysis adjusting for age, ORP versus RARP procedure, Gleason score, BMI, first PSA, comorbidity, ethnicity, and baseline PORPUS scores, PORPUS score was higher for the RARP group at 3 months (p = 0.038) and 9 months (p = 0.037), but not at 6, 12, and 15 months (p = 0.014). No difference met pre-defined thresholds of clinical significant.
Though unadjusted HRQoL outcomes appeared improved with RARP compared to ORP differences, adjusted differences were seen at only 2 of 5 postoperative time points, and did not meet pre-defined thresholds of clinical significance. Further randomized trials are needed to assess whether one treatment option provides consistently better HRQoL outcomes.
与开放性前列腺切除术（ORP）相比，机器人辅助根治性前列腺切除术（RARP）在健康相关生活质量（HRQoL）方面的结果是否更优尚不清楚。
我们回顾性分析了2009年1月至2012年12月期间在我院接受ORP或RARP治疗的男性患者的记录。患者在手术前以及术后每3个月直至术后15个月完成一份人口统计学调查问卷和患者导向前列腺效用量表（PORPUS），这是一种经过验证的针对特定疾病的HRQoL工具。
共有974名男性符合纳入标准（643例ORP患者和331例RARP患者）。在基线时，RARP患者明显更年轻（p < 0.001），体重指数（BMI）更低（p < 0.001），术前前列腺特异性抗原（PSA）更低（p < 0.001），合并症更少（p < 0.004），且基线PORPUS评分更高（p = 0.024）。在随访中，RARP组在每个时间点的未调整PORPUS评分均显著更高。在对年龄、ORP与RARP手术、Gleason评分、BMI、首次PSA、合并症、种族和基线PORPUS评分进行多变量分析时，RARP组在3个月（p = 0.038）和9个月（p = 0.037）时的PORPUS评分更高，但在6、12和15个月时则不然（p = 0.014）。没有差异达到预先定义的临床显著性阈值。
尽管与ORP相比，未调整的HRQoL结果显示RARP有所改善，但调整后的差异仅在术后5个时间点中的2个出现，且未达到预先定义的临床显著性阈值。需要进一步的随机试验来评估一种治疗选择是否始终能提供更好的HRQoL结果。
