Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
World J Urol. 2020 Dec;38(12):3075-3083. doi: 10.1007/s00345-020-03144-9. Epub 2020 Mar 4.
Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse.
In the current retrospective analysis, inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p < 0.05).
Open retropubic prostatectomy and RARP cohorts were well balanced. General HRQOL was significantly higher for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not at the remaining follow-up time points. There were no significant differences for the remaining QLQ-C30 functioning and symptom scores. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as a marginally independent predictor for lower ratios of good general HRQOL after 3 months (OR 0.464, 95% CI 0.215-0.999; p = 0.050) without any differences at the remaining time points.
The current study addresses various HRQOL outcomes over a postoperative period of up to 2 years in a homogenous propensity score-matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3 months postoperatively.
机器人辅助根治性前列腺切除术（RARP）的引入彻底改变了局限性前列腺癌（PCa）的治疗格局。然而，关于 RARP 和开放式经耻骨前列腺切除术（ORP）后健康相关生活质量（HRQOL）的比较分析很少。
在当前的回顾性分析中，纳入标准包括 PSA≤10ng/ml、≤pT2c、ISUP≤3、年龄≤65 岁和术前控尿。创建了一个倾向评分匹配的患者队列[n=418（ORP：209，RARP：209）]，并使用经过验证的问卷（EORTC QLQ-C30）在术前、术后 3 个月、12 个月和 24 个月进行前瞻性评估 HRQOL。主要终点是基于先前发表的截止值评估的良好一般 HRQOL。通过 IIEF-5 测量勃起功能，通过 ICIQ-SF 问卷测量尿控。多变量分析包括二元逻辑回归模型（p<0.05）。
开放式经耻骨前列腺切除术和 RARP 队列平衡良好。与 RARP 相比，ORP 在术后 3 个月时的一般 HRQOL 显著更高（70.1 对 61.6，p=0.001），但在其余随访时间点没有显著差异。QLQ-C30 功能和症状评分无显著差异。在按 IIEF-5 和 ICIQ-SF 评分和外科医生经验分层的多变量分析中，RARP 可以被确认为术后 3 个月时一般 HRQOL 较低比例的边缘独立预测因素（OR 0.464，95%CI 0.215-0.999；p=0.050），而在其余时间点没有差异。
本研究在一个同质的倾向评分匹配的当代队列中，在术后长达 2 年的时间内，针对各种 HRQOL 结果进行了研究。与 RARP 相比，ORP 在术后 3 个月时的一般 HRQOL 结果略有改善。
