机器人辅助与开放性根治性前列腺切除术治疗后癌症控制和生存的比较效果。
Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy.
机构信息
Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York.
Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York; Department of Urology, Dalhousie University, Halifax, Canada.
出版信息
J Urol. 2017 Jan;197(1):115-121. doi: 10.1016/j.juro.2016.09.115. Epub 2016 Oct 5.
PURPOSE
Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer. Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify the higher cost relative to open surgery. We examined the comparative effectiveness of robot-assisted vs open radical prostatectomy in cancer control and survival in a nationally representative population.
MATERIALS AND METHODS
This population based observational cohort study of patients with prostate cancer undergoing robot-assisted radical prostatectomy and open radical prostatectomy during 2003 to 2012 used data captured in the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database. Propensity score matching and time to event analysis were used to compare all cause mortality, prostate cancer specific mortality and use of additional treatment after surgery.
RESULTS
A total of 6,430 robot-assisted radical prostatectomies and 9,161 open radical prostatectomies performed during 2003 to 2012 were identified. The use of robot-assisted radical prostatectomy increased from 13.6% in 2003 to 2004 to 72.6% in 2011 to 2012. After a median followup of 6.5 years (IQR 5.2-7.9) robot-assisted radical prostatectomy was associated with an equivalent risk of all cause mortality (HR 0.85, 0.72-1.01) and similar cancer specific mortality (HR 0.85, 0.50-1.43) vs open radical prostatectomy. Robot-assisted radical prostatectomy was also associated with less use of additional treatment (HR 0.78, 0.70-0.86).
CONCLUSIONS
Robot-assisted radical prostatectomy has comparable intermediate cancer control as evidenced by less use of additional postoperative cancer therapies and equivalent cancer specific and overall survival. Longer term followup is needed to assess for differences in prostate cancer specific survival, which was similar during intermediate followup. Our findings have significant quality and cost implications, and provide reassurance regarding the adoption of more expensive technology in the absence of randomized controlled trials.
目的
机器人辅助手术已在美国迅速应用于前列腺癌治疗。其应用受到市场力量和患者偏好的推动，而关于与开放手术相比，它是否能提供更好的结果来证明其更高的成本是否合理，这一问题仍存在争议。我们在全国代表性人群中检查了机器人辅助与开放根治性前列腺切除术在癌症控制和生存方面的比较效果。
材料和方法
这项基于人群的观察性队列研究，对 2003 年至 2012 年期间接受机器人辅助根治性前列腺切除术和开放根治性前列腺切除术的前列腺癌患者，使用了从 SEER（监测、流行病学和最终结果）-医疗保险链接数据库中捕获的数据。采用倾向评分匹配和时间事件分析比较了手术后的全因死亡率、前列腺癌特异性死亡率和额外治疗的使用情况。
结果
共确定了 2003 年至 2012 年期间进行的 6430 例机器人辅助根治性前列腺切除术和 9161 例开放根治性前列腺切除术。机器人辅助根治性前列腺切除术的使用率从 2003 年至 2004 年的 13.6%上升到 2011 年至 2012 年的 72.6%。中位随访 6.5 年（IQR 5.2-7.9）后，机器人辅助根治性前列腺切除术与全因死亡率（HR 0.85，0.72-1.01）和前列腺癌特异性死亡率（HR 0.85，0.50-1.43）相当。与开放根治性前列腺切除术相比，机器人辅助根治性前列腺切除术也与较少的额外治疗（HR 0.78，0.70-0.86）有关。
结论
机器人辅助根治性前列腺切除术在中间期癌症控制方面具有相当的效果，表现为术后癌症治疗的使用率较低，以及前列腺癌特异性和总体生存率相似。需要进行更长期的随访，以评估前列腺癌特异性生存率的差异，在中期随访期间，这一结果相似。我们的发现具有重要的质量和成本意义，并为在没有随机对照试验的情况下采用更昂贵的技术提供了保证。
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