10000 例机器人辅助腹腔镜前列腺切除术患者的临床趋势变化及 2012 年美国预防服务工作组关于 PSA 筛查声明的影响。

Changing clinical trends in 10 000 robot-assisted laparoscopic prostatectomy patients and impact of the 2012 US Preventive Services Task Force's statement against PSA screening.

机构信息

Florida Hospital Global Robotics Institute, Celebration, FL, USA.

Wesley Urology Clinic, Auchenflower, QLD, Australia.

出版信息

BJU Int. 2019 Dec;124(6):1014-1021. doi: 10.1111/bju.14866. Epub 2019 Aug 1.

DOI:10.1111/bju.14866

PMID:31301265

Abstract

OBJECTIVES

To evaluate the clinical trend changes in our robot-assisted laparoscopic prostatectomy (RALP) practice and to investigate the effect of 2012 US Preventive Services Task Force (USPSTF) statement against PSA screening on these trends.

PATIENTS AND METHODS

Data of 10 000 RALPs performed by a single surgeon between 2002 and 2017 were retrospectively analysed. Time trends in successive 1000 cases for clinical, surgical and pathological characteristics were analysed with linear and logistic regression. Time-trend changes before and after the USPSTF's statement were compared using a logistic regression model and likelihood-ratio test.

RESULTS

Unfavourable cancer characteristics rate, including D'Amico high risk, pathological non-organ-confined disease and Gleason score ≥4+4 increased from 11.5% to 23.3%, 14% to 42.5%, and 7.7% to 20.9%, respectively, over time (all P < 0.001). Significant time-trend changes were detected after the USPSTF's statement with an increase in the positive trend of Gleason ≥4+4 and increase in the negative trends of Gleason ≤3+4 tumours. There was a significant negative trend in the rate of full nerve-sparing (NS) with a decrease from 59.3% to 35.7%, and a significant positive trend in partial NS with an increase from 15.8% to 62.5% over time (both P < 0.001). The time-trend slope in 'high-grade' partial NS significantly decreased and 'low-grade' partial NS significantly increased after the USPSTF's statement. The overall positive surgical margin rate increased from 14.6% to 20.3% in the first vs last 1000 cases (P < 0.001), with a significant positive slope after the USPSTF's statement.

CONCLUSIONS

The proportion of high-risk patients increased in our series over time with a significant impact of the USPSTF's statement on pathological time trends. This stage migration resulted in decreased utilisation of high-quality NS and increased performance of poor-quality NS.

摘要

目的

评估我们机器人辅助腹腔镜前列腺切除术（RALP）实践中的临床趋势变化，并研究 2012 年美国预防服务工作组（USPSTF）针对 PSA 筛查的声明对这些趋势的影响。

患者与方法

回顾性分析了 2002 年至 2017 年间一位外科医生进行的 10000 例 RALP 数据。使用线性和逻辑回归分析连续 1000 例患者的临床、手术和病理特征的时间趋势。使用逻辑回归模型和似然比检验比较 USPSTF 声明前后的时间趋势变化。

结果

不利的癌症特征率，包括 D'Amico 高危、病理非器官局限疾病和 Gleason 评分≥4+4，从 11.5%增加到 23.3%、14%增加到 42.5%和 7.7%增加到 20.9%（均 P<0.001）。在 USPSTF 声明后，发现了显著的时间趋势变化，Gleason≥4+4 的阳性趋势增加，Gleason≤3+4 肿瘤的阴性趋势增加。全神经保留（NS）的比例有显著的负趋势，从 59.3%下降到 35.7%，部分 NS 的比例有显著的正趋势，从 15.8%增加到 62.5%（均 P<0.001）。在 USPSTF 声明后，“高级别”部分 NS 的时间趋势斜率显著下降，“低级别”部分 NS 的斜率显著增加。在第一和最后 1000 例中，总体阳性切缘率从 14.6%增加到 20.3%（P<0.001），在 USPSTF 声明后有显著的正斜率。