Jang Won Sik, Kim Myung Soo, Jeong Won Sik, Chang Ki Don, Cho Kang Su, Ham Won Sik, Rha Koon Ho, Hong Sung Joon, Choi Young Deuk
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
BJU Int. 2018 Feb;121(2):225-231. doi: 10.1111/bju.13992. Epub 2017 Sep 11.
To investigate the peri-operative and oncological outcomes of robot-assisted radical prostatectomy (RARP) in patients with oligometastatic prostate cancer (PCa).
We retrospectively reviewed the records of 79 patients with oligometastatic PCa treated with RARP or androgen deprivation therapy (ADT) between 2005 and 2015 at our institution. Of these 79 patients, 38 were treated with RARP and 41 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated peri-operative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analysed data using Kaplan-Meier methods, with log-rank tests and multivariate Cox regression models.
Patients treated with RARP experienced similar postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than ADT-treated patients. PFS and CSS were longer in RARP-treated compared with ADT-treated patients (median PFS: 75 vs 28 months, P = 0.008; median CSS: not reached vs 40 months, P = 0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR] 0.388, P = 0.003; CSS: HR 0.264, P = 0.004).
We showed that RARP in the setting of oligometastatic PCa is a safe and feasible procedure which improves oncological outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. The study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa; to confirm our findings, large, prospective, multicentre studies are required.
探讨机器人辅助根治性前列腺切除术（RARP）治疗寡转移前列腺癌（PCa）患者的围手术期及肿瘤学结局。
我们回顾性分析了2005年至2015年间在我院接受RARP或雄激素剥夺治疗（ADT）的79例寡转移PCa患者的记录。在这79例患者中，38例接受了RARP治疗，41例接受了未进行局部治疗的ADT。寡转移疾病定义为术前骨扫描检测到的热点不超过5个。我们评估了围手术期结局、无进展生存期（PFS）和癌症特异性生存期（CSS）。我们使用Kaplan-Meier方法、对数秩检验和多变量Cox回归模型分析数据。
接受RARP治疗的患者术后并发症与先前报道的接受根治性前列腺切除术（RP）治疗的患者相似，且泌尿系统并发症少于接受ADT治疗的患者。与接受ADT治疗的患者相比，接受RARP治疗的患者的PFS和CSS更长（中位PFS：75个月对28个月，P = 0.008；中位CSS：未达到对40个月，P = 0.002）。多变量分析进一步确定RARP是PFS和CSS的显著预测因素（PFS：风险比[HR] 0.388，P = 0.003；CSS：HR 0.264，P = 0.004）。
我们表明，在寡转移PCa患者中，RARP是一种安全可行的手术，可改善PFS和CSS方面的肿瘤学结局。此外，我们的数据表明，RARP有效地预防了PCa的泌尿系统并发症。该研究突出了专家外科医生和经过严格挑选的患者的结果，这些结果不能外推至所有寡转移PCa患者；为了证实我们的发现，需要进行大型、前瞻性、多中心研究。
