Jo Jung Ki, Oh Jong Jin, Lee Sangchul, Jeong Seong Jin, Hong Sung Kyu, Byun Seok-Soo, Lee Sang Eun
Department of Urology, Hanynag University College of Medicine, Seoul, Korea.
Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
World J Urol. 2017 Apr;35(4):605-612. doi: 10.1007/s00345-016-1893-4. Epub 2016 Aug 1.
To identify the perioperative and oncological impact of different intervals between biopsy and robot-assisted laparoscopic radical prostatectomy (RALP) for localized prostate cancer.
All consecutive patients with localized prostate cancer who underwent RALP with primary curative intent in January 2008-July 2014 in a large tertiary hospital were enrolled in this retrospective cohort study. The patients were divided into groups according to whether the biopsy-RALP interval was ≤2, ≤4, ≤6, or >6 weeks. Estimated blood loss and operating room time were surrogates for surgical difficulty. Surgical margin status and continence at the 1 year were surrogates for surgical efficacy. Biochemical recurrence (BCR) was defined as two consecutive postoperative prostate serum antigen values of ≥0.2 ng/ml.
Of the 1446 enrolled patients, the biopsy-RALP interval was ≤2, ≤4, ≤6, and >6 weeks in 145 (10 %), 728 (50.3 %), 1124 (77.7 %), and 322 (22.3 %) patients, respectively. The >6 week group had a significantly longer mean operation time than the ≤2, ≤4, and ≤6 week groups. The groups did not differ significantly in terms of estimated blood loss or surgical margin status. Kaplan-Meier analysis showed that interval did not significantly affect postoperative BCR-free survival. Multivariable Cox proportional hazards model analysis showed that interval duration was not an independent predictor of BCR (≤2 vs. >2 weeks, HR = 0.859, p = 0.474; ≤4 vs. >4 weeks, HR = 1.029, p = 0.842; ≤6 vs. >6 weeks, HR = 0.84, p = 0.368).
Performing RALP within 2, 4, or 6 weeks of biopsy does not appear to adversely influence surgical difficulty or efficacy or oncological outcomes.
确定局限性前列腺癌活检与机器人辅助腹腔镜根治性前列腺切除术（RALP）之间不同间隔时间对围手术期及肿瘤学的影响。
本回顾性队列研究纳入了2008年1月至2014年7月期间在一家大型三级医院接受以根治为主要目的RALP的所有连续性局限性前列腺癌患者。根据活检与RALP的间隔时间是否≤2周、≤4周、≤6周或>6周将患者分组。估计失血量和手术时间作为手术难度的指标。手术切缘状态和术后1年的控尿情况作为手术疗效的指标。生化复发（BCR）定义为术后连续两次前列腺血清抗原值≥0.2 ng/ml。
在1446例纳入患者中，活检与RALP间隔时间≤2周、≤4周、≤6周和>6周的患者分别有145例（10%）、728例（50.3%）、1124例（77.7%）和322例（22.3%）。>6周组的平均手术时间明显长于≤2周、≤4周和≤6周组。各组在估计失血量或手术切缘状态方面无显著差异。Kaplan-Meier分析显示，间隔时间对术后无BCR生存率无显著影响。多变量Cox比例风险模型分析显示，间隔时间不是BCR的独立预测因素（≤2周与>2周，HR = 0.859，p = 0.474；≤4周与>4周，HR = 1.029，p = 0.842；≤6周与>6周，HR = 0.84，p = 0.368）。
在活检后2周、4周或6周内进行RALP似乎不会对手术难度、疗效或肿瘤学结局产生不利影响。
