前列腺癌挽救性机器人辅助根治性前列腺切除术的围手术期、肿瘤学和功能结局的影响：聚焦治疗的作用。

Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy.

机构信息

Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil.

Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.

出版信息

J Urol. 2017 Nov;198(5):1069-1076. doi: 10.1016/j.juro.2017.05.071. Epub 2017 May 25.

DOI:10.1016/j.juro.2017.05.071

PMID:28551444

Abstract

PURPOSE

We assessed the impact of focal therapy on perioperative, oncologic and functional outcomes in men who underwent salvage robotic assisted radical prostatectomy compared to primary robotic assisted radical prostatectomy.

MATERIALS AND METHODS

Focal therapy was performed in patients presenting with Gleason score 3 + 3 or 3 + 4, clinical stage cT2a or less, serum prostate specific antigen 15 ng/ml or less, unilateral positive biopsy, maximum length of any positive core less than 10 mm and life expectancy greater than 10 years. Focal therapy was defined as target ablation of the index lesion plus a 1 cm safety margin in the normal ipsilateral prostatic parenchyma. The salvage group included 22 men who underwent salvage prostatectomy after focal therapy failure. The primary group was defined using matched pair 1:2 selection of 44 of 2,750 patients treated with primary prostatectomy. The primary and secondary end points were the between group differences in functional and oncologic outcomes, respectively.

RESULTS

Complication rates were comparable (p >0.05). Pad-free probability was comparable between the groups at 1 and 2 years (p = 0.8). Recovery of erectile function was significantly lower after salvage robotic assisted radical prostatectomy (p = 0.008), which also showed a significantly lower probability of cumulative biochemical recurrence-free survival compared to primary robotic assisted radical prostatectomy (56.3% vs 92.4% at 2 years, p = 0.001). Salvage prostatectomy demonstrated a significantly increased risk of biochemical recurrence (HR 4.8, 95% CI 1.67-13.76, p = 0.004). Study limitations included the retrospective nature, the lack of randomization and the short followup.

CONCLUSIONS

Salvage robotic assisted radical prostatectomy after focal therapy failure is feasible with acceptable complication rates. However, patients assigned to primary focal therapy should be advised about a poorer prognosis in terms of oncologic control and lower erectile recovery rates in case of a future salvage surgery.

摘要

目的

我们评估了与原发性机器人辅助根治性前列腺切除术相比，在接受挽救性机器人辅助根治性前列腺切除术的患者中，局灶性治疗对围手术期、肿瘤学和功能结果的影响。

材料和方法

局灶性治疗适用于以下患者：Gleason 评分 3+3 或 3+4、临床分期 cT2a 或更低、血清前列腺特异性抗原 15ng/ml 或更低、单侧阳性活检、任何阳性核心的最大长度小于 10mm 以及预期寿命大于 10 年。局灶性治疗定义为靶病变的靶向消融加上正常同侧前列腺实质中 1cm 的安全边缘。挽救组包括 22 例在局灶性治疗失败后接受挽救性前列腺切除术的患者。原发性组通过对 2750 例接受原发性前列腺切除术的患者进行 1:2 配对选择，纳入 44 例患者进行定义。主要和次要终点分别是两组之间功能和肿瘤学结果的差异。

结果

并发症发生率无差异（p>0.05）。两组在 1 年和 2 年时无尿垫的概率相当（p=0.8）。挽救性机器人辅助根治性前列腺切除术后勃起功能恢复明显较低（p=0.008），与原发性机器人辅助根治性前列腺切除术相比，累积生化无复发生存率也明显较低（2 年时为 56.3%vs92.4%，p=0.001）。挽救性前列腺切除术显示出明显增加的生化复发风险（HR4.8，95%CI1.67-13.76，p=0.004）。研究局限性包括回顾性、缺乏随机化和随访时间短。