机器人辅助根治性前列腺切除术的肿瘤学结果：一项具有 10 年中位随访时间的大型欧洲单中心队列研究。

Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up.

机构信息

Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK; Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.

Department of Urology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Eur Urol Focus. 2018 Apr;4(3):351-359. doi: 10.1016/j.euf.2016.10.007. Epub 2016 Nov 2.

DOI:10.1016/j.euf.2016.10.007

PMID:28753802

Abstract

BACKGROUND

Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy.

OBJECTIVE

To evaluate long-term oncologic outcomes following RARP.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016.

INTERVENTION

RARP as monotherapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Biochemical recurrence (BCR)-free survival (BCRFS), salvage therapy (ST)-free survival (STFS), prostate cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models.

RESULTS AND LIMITATIONS

We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3mm/multifocal but not ≤3mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes.

CONCLUSIONS

RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3mm PSM, but further follow-up is required to determine any impact on CSS.

PATIENT SUMMARY

Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.

摘要

背景

机器人辅助根治性前列腺切除术（RARP）已被广泛应用于前列腺癌（PCa）的治疗，但长期（>5 年）肿瘤疗效的证据有限。

目的

评估 RARP 后的长期肿瘤学结果。

设计、地点和参与者：这是一项前瞻性队列研究，纳入了 885 例于 2002 年至 2006 年在欧洲单一中心接受 RARP 作为单一疗法治疗 PCa 的患者，并随访至 2016 年。

干预措施

RARP 作为单一疗法。

观察指标和统计分析

使用 Kaplan-Meier 法估计无生化复发（BCR）生存（BCRFS）、挽救治疗（ST）无生存（STFS）、前列腺癌特异性生存（CSS）和总生存（OS），使用对数秩检验比较事件时间分布。使用 Cox 比例风险模型确定与 BCR 和 ST 相关的预测变量。

结果和局限性

我们发现 167 例 BCR、110 例 ST、16 例 PCa 相关死亡和 51 例其他/未知原因死亡。中位随访 10.5 年后，BCRFS、STFS、CSS 和 OS 率分别为 81.8%、87.5%、98.5%和 93.0%。多变量分析显示，术前 Gleason 评分、病理 T 分期、阳性切缘（PSM）和术前前列腺特异性抗原是 BCR 和 ST 的最强独立预测因素。PSM>3mm/多灶性但不是≤3mm 独立影响 BCR 和 ST 的风险。研究局限性包括缺乏中央组织病理学报告、历史队列中的淋巴结和术后肿瘤体积数据以及患者报告的结果。