Roberts Matthew J, Papa Nathan, Perera Marlon, Joshi Andre, Scott Susan, Bolton Damien, Lawrentschuk Nathan, Yaxley John
Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.
Asia Pac J Clin Oncol. 2020 Apr;16(2):e118-e124. doi: 10.1111/ajco.13158. Epub 2019 May 6.
To describe national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy and consideration of robotic-assisted techniques.
Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2001-2016 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy relative to total and PCa-specific populations among men aged 45-84 years. Proportion of cases performed robotically was considered.
Total procedures performed increased from 2001, peaked in 2009 and subsequently decreased until 2016. Since 2009, the age-specific rate of surgery in men aged 75-84 increased by 2.3-fold, whereas the rates for men aged 55-64 and 45-54 reduced by 44% and 55%, respectively. Rates of concurrent pelvic lymphadenectomy fell until 2009 with subsequent stabilization (ratio 1.05-1.14) through to 2016. Significant regional practice patterns were observed, as was an increasing trend toward a robotic-assisted laparoscopic approach, comprising more than 80% of radical prostatectomies in 2016.
Since the peak in 2009, radical prostatectomy is performed less in men <65 years and more in men ≥65 years. An increasing proportion of cases omit concurrent pelvic lymphadenectomy and are performed robotically.
描述前列腺癌（PCa）的全国手术治疗模式，包括是否进行盆腔淋巴结清扫的根治性前列腺切除术以及机器人辅助技术的应用情况。
对2001 - 2016年期间可公开获取的医疗保险索赔数据进行回顾性分析，纳入45 - 84岁男性中接受了有或无盆腔淋巴结清扫的根治性前列腺切除术的患者，相对于总人群和PCa特定人群。考虑了机器人手术的病例比例。
手术总数从2001年开始增加，在2009年达到峰值，随后下降直至2016年。自2009年以来，75 - 84岁男性的年龄特异性手术率增加了2.3倍，而55 - 64岁和45 - 54岁男性的手术率分别下降了44%和55%。同期盆腔淋巴结清扫率在2009年之前下降，随后趋于稳定（比例为1.05 - 1.14）直至2016年。观察到显著的地区实践模式，以及机器人辅助腹腔镜手术方法的增加趋势，2016年超过80%的根治性前列腺切除术采用该方法。
自2009年达到峰值以来，65岁以下男性进行根治性前列腺切除术的比例降低，65岁及以上男性的比例增加。越来越多的病例省略同期盆腔淋巴结清扫，且采用机器人手术。
