Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Prostate Cancer Prostatic Dis. 2021 Mar;24(1):193-201. doi: 10.1038/s41391-020-00266-4. Epub 2020 Aug 19.
To investigate the oncologic safety of neurovascular bundles (NVB) preservation at radical prostatectomy (RP) in patients with high-risk and/or locally advanced prostate cancer (PCa).
Within a two-institutional high-volume center database we identified patients who harbored high-risk PCa at RP (2000-2017). Only patients with D'Amico high-risk PCa were included. Kaplan-Meier and multivariable Cox regression models tested the effect of NVB preservation on biochemical recurrence (BCR), metastasis and overall survival (OS). Subgroup analyses focused on patients with clinical stage T3 and/or biopsy ISUP grade 5 and pathologic stage T3.
Of 4351 patients with D'Amico high-risk, 35.7% vs. 38.0% vs. 26.3% underwent bilateral vs. unilateral vs. no NVB preservation, respectively. At 120 months after RP BCR-free, metastasis-free survival and OS rates were 62.2% vs. 44.3% vs. 27.1% (p < 0.001), 83.7% vs. 66.7% vs. 60.3% (p < 0.001), and 91.8% vs. 87.5% vs. 72.3% (p < 0.001) for bilateral vs. unilateral vs. no NVB preservation, respectively. In multivariable Cox regression models, bilateral and unilateral compared to no NVB preservation did not increase the risk for BCR, metastasis or death in the entire cohort and in subgroups with clinical stage T3 and/or biopsy ISUP grade 5, as well as pathologic stage T3.
NVB preservation was not associated with worse oncological outcome in patients with high-risk and/or locally advanced PCa and may be offered to well-selected patients who are at risk of harboring nonorgan-confined PCa.
研究在根治性前列腺切除术（RP）中保留神经血管束（NVB）对高危和/或局部晚期前列腺癌（PCa）患者的肿瘤安全性。
在一个两机构高容量中心数据库中，我们确定了在 RP 中患有高危 PCa 的患者（2000-2017 年）。仅包括具有 D'Amico 高危 PCa 的患者。Kaplan-Meier 和多变量 Cox 回归模型测试了 NVB 保留对生化复发（BCR）、转移和总生存（OS）的影响。亚组分析集中在临床分期 T3 和/或活检 ISUP 分级 5 和病理分期 T3 的患者。
在 4351 名具有 D'Amico 高危的患者中，分别有 35.7%、38.0%和 26.3%接受了双侧、单侧和无 NVB 保留。在 RP 后 120 个月，BCR 无复发生存率、无转移生存率和 OS 率分别为 62.2%、44.3%和 27.1%（p<0.001），83.7%、66.7%和 60.3%（p<0.001）和 91.8%、87.5%和 72.3%（p<0.001），双侧、单侧与无 NVB 保留相比。在多变量 Cox 回归模型中，双侧和单侧与无 NVB 保留相比，在整个队列和临床分期 T3 和/或活检 ISUP 分级 5 以及病理分期 T3 的亚组中，并未增加 BCR、转移或死亡的风险。
在高危和/或局部晚期 PCa 患者中，保留 NVB 与肿瘤学结果不佳无关，并且可以为存在非器官受限 PCa 风险的精选患者提供。
