VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
Prostate Cancer Prostatic Dis. 2017 Dec;20(4):395-400. doi: 10.1038/pcan.2017.26. Epub 2017 May 2.
To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa).
Retrospective analyses of a prospectively maintained database for 769 patients with D'Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score ⩾17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively.
Mean age of the cohort was 62.3 years, and 62.1% harbored ⩾PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan-Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM ⩾17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation.
Patients with D'Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.
确定机器人辅助根治性前列腺切除术（RARP）治疗临床高危前列腺癌（PCa）后 3 年的尿控（UC）和性功能（SF）恢复情况。
对 2001 年至 2014 年期间在美国和欧洲的两个三级保健中心接受 RARP 的 769 例 D'Amico 高危 PCa 患者的前瞻性维护数据库进行回顾性分析。在单独的术前和术后 Cox 比例风险回归模型中，检验了 RARP 后时间与 UC（定义为每天 0 个护垫/一个安全衬垫）和 SF（定义为男性健康问卷（SHIM）评分 ⩾17）恢复之间的关系。使用 UC 和 SF 恢复的每天 0 个护垫和足以进行性交的勃起作为终点进行了敏感性分析。
队列的平均年龄为 62.3 岁，62.1%的患者存在 ⩾PT3a 疾病。87.7%的患者接受了神经保留（单侧或双侧）RARP。手术后 12、24 和 36 个月的 UC 恢复的 Kaplan-Meier 估计值分别为 85.2%、89.1%和 91.2%，而术前（SHIM ⩾17；n=548；71.3%）有性功能的患者中有 33.8%、52.3%和 69.0%恢复了 SF。在敏感性分析中也观察到了类似的结果。患者年龄和手术年份与 UC 和 SF 恢复有关；此外，术前 SHIM 评分、神经保留程度、pT3b-T4 疾病和手术切缘与观察期内的 SF 恢复有关。
接受 RARP 治疗的 D'Amico 高危 PCa 患者可能会在手术后 12 个月后继续恢复 UC 和 SF，并在 3 年随访时显示出有前途的结果。适当的患者选择和咨询可能有助于为 RARP 后功能恢复设定现实的期望。
