Schiffmann Jonas, Haese Alexander, Boehm Katharina, Salomon Georg, Steuber Thomas, Heinzer Hans, Huland Hartwig, Graefen Markus, Karakiewicz Pierre I
Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany -
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada -
Minerva Urol Nefrol. 2017 Feb;69(1):69-75. doi: 10.23736/S0393-2249.16.02563-7. Epub 2016 Mar 9.
Patients treated with robot-assisted radical prostatectomy (RARP) are frequently selected according to more favorable characteristics. Such patient selection might decrease according to increasing experience.
We relied on the Martini Clinic Prostate Cancer Center database and focused on patients treated with RARP between 2004 and 2013. Differences in clinical, pathological and surgical characteristics at RARP over time (2004-2010, 2011-2012 and 2013) were assessed.
Overall, 1783 RARP patients were identified. Of those, 407 (22.8%), 764 (42.8%) and 612 (34.3%) were treated between 2004 and 2010, in 2011-2012 and in 2013, respectively. Unfavorable characteristics rate, such as biopsy Gleason Score ≥4+4 (8 vs. 9 vs. 15%, P<0.001), D'Amico high-risk (12 vs. 14 vs. 19%, P=0.001) and pathological Gleason score ≥4+4 (3 vs. 4 vs. 6%, P<0.001) increased over time. Pelvic lymph node dissection (PLND) was more frequently performed over time (62 vs. 83 vs. 84%, P<0.001), especially in D'Amico intermediate or high-risk patients (82 vs. 94 vs. 96%, P<0.001). Lymph node yield increased over time in overall (7 vs. 9 vs. 13, P<0.001), D'Amico intermediate (6 vs. 9 vs. 12, P<0.001) and D'Amico high-risk patients (9 vs. 12 vs. 18, P<0.001). No differences in surgical margin (P=0.7) and nerve sparing rates (P=0.09) were found.
A clear trend towards more unfavorable tumor characteristics over time was recorded. Additionally, the rates and extent of PLND increased with increasing experience. RAR P does not represent a barrier to PLND at our institution.
接受机器人辅助根治性前列腺切除术（RARP）的患者通常是根据更有利的特征来选择的。随着经验的增加，这种患者选择可能会减少。
我们依据马丁尼诊所前列腺癌中心数据库，重点关注2004年至2013年间接受RARP治疗的患者。评估了不同时间（2004 - 2010年、2011 - 2012年和2013年）RARP患者的临床、病理和手术特征差异。
总体上，共识别出1783例RARP患者。其中，分别有407例（22.8%）、764例（42.8%）和612例（34.3%）在2004年至2010年、2011 - 2012年和2013年接受治疗。不利特征发生率，如活检Gleason评分≥4 + 4（8%对9%对15%，P < 0.001）、达米科高危（12%对14%对19%，P = 0.001）和病理Gleason评分≥4 + 4（3%对4%对6%，P < 0.001）随时间增加。盆腔淋巴结清扫术（PLND）随着时间推移更频繁地进行（62%对83%对84%，P < 0.001），尤其是在达米科中危或高危患者中（82%对94%对96%，P < 0.001）。总体上、达米科中危患者和达米科高危患者的淋巴结获取数量随时间增加（分别为7个对9个对13个，P < 0.001；6个对9个对12个，P < 0.001；9个对12个对18个，P < 0.001）。在手术切缘（P = 0.7）和保留神经率（P = 0.09）方面未发现差异。
记录到肿瘤特征随时间越来越不利的明显趋势。此外，PLND的发生率和范围随着经验增加而增加。在我们机构，RARP并非PLND的障碍。
