Hirasawa Yosuke, Ohori Makoto, Sugihara Toru, Hashimoto Takeshi, Satake Naoya, Gondo Tatsuo, Nakagami Yoshihiro, Namiki Kazunori, Yoshioka Kunihiko, Nakashima Jun, Tachibana Masaaki, Ohno Yoshio
Department of Urology, Tokyo Medical University, Tokyo.
Department of Urology, SHIN-YURIGAOKA General Hospital, Kanagawa.
Jpn J Clin Oncol. 2017 Nov 1;47(11):1083-1089. doi: 10.1093/jjco/hyx125.
To investigate the impact of the time interval (TI) between prostate biopsy and robot-assisted radical prostatectomy (RARP) on the risk of biochemical recurrence (BCR).
We retrospectively reviewed the medical records of 793 consecutive patients who were treated with RARP at our institution. Patients were divided into three groups, according to TI, to compare BCR-free survival (BCRFS) rates: Group 1 (n = 196), TI < 3 months; Group 2 (n = 513), 3 ≤ TI < 6 months; Group 3 (n = 84), TI ≥ 6 months. Eighty-three patients with TI ≥ 6 months were matched with an equal number of patients with TI < 6 months based on propensity scores by using four preoperative factors: prostate-specific antigen (PSA), primary (pGS) and secondary (sGS) Gleason score and positive prostate biopsy.
The 5-year BCRFS rates for TI Groups 1, 2, and 3 were 76%, 80.7% and 82.6% (P = 0.99), respectively. The multivariate analysis revealed that PSA, pGS, sGS and a positive prostate biopsy were independent preoperative risk factors for BCR. The propensity adjusted 5-year BCRFS for patients with TI ≥ 6 months was 84.0%. This was not worse than that of patients with TI < 6 months (71.0%, P = 0.18).
In our cohorts, a delay in the time from biopsy to RARP did not significantly affect recurrence. Therefore, hasty treatment decisions are unnecessary for at least 6 months after diagnosis of early prostate cancer.
探讨前列腺活检与机器人辅助根治性前列腺切除术(RARP)之间的时间间隔(TI)对生化复发(BCR)风险的影响。
我们回顾性分析了在本机构接受RARP治疗的793例连续患者的病历。根据TI将患者分为三组,以比较无BCR生存(BCRFS)率:第1组(n = 196),TI < 3个月;第2组(n = 513),3≤TI < 6个月;第3组(n = 84),TI≥6个月。基于术前四个因素:前列腺特异性抗原(PSA)、原发性(pGS)和继发性(sGS)Gleason评分以及前列腺活检阳性,通过倾向评分将83例TI≥6个月的患者与相同数量的TI < 6个月的患者进行匹配。
TI第1、2和3组的5年BCRFS率分别为76%、80.7%和82.6%(P = 0.99)。多因素分析显示,PSA、pGS、sGS和前列腺活检阳性是BCR的独立术前危险因素。TI≥6个月患者的倾向调整5年BCRFS为84.0%。这并不比TI < 6个月的患者差(71.0%,P = 0.18)。
在我们的队列中,从活检到RARP的时间延迟并未显著影响复发。因此,对于早期前列腺癌诊断后至少6个月内无需匆忙做出治疗决定。