日本机器人辅助腹腔镜前列腺癌根治术后前列腺癌患者三结局的纵向分析。
Longitudinal analysis of trifecta outcome in Japanese patients with prostate cancer following robot-assisted laparoscopic radical prostatectomy.
机构信息
Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
出版信息
World J Urol. 2022 Aug;40(8):2009-2015. doi: 10.1007/s00345-020-03515-2. Epub 2020 Nov 13.
PURPOSE
To analyze the trifecta outcome (continence, potency, and cancer control) longitudinally using robot-assisted laparoscopic radical prostatectomy (RARP).
METHOD
We prospectively obtained 1-year longitudinal Expanded Prostate Cancer Index Composite (EPIC) data (preoperative and at 3, 6, 9, and 12 months after RARP) from 291 patients who underwent RARP by a single surgeon. Continence was defined as the use of 'zero or one pads'. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual activity or sexual intercourse. Continence and potency were subjectively determined from patient-reported outcomes (EPIC question nos. 5 and 18). The biochemical recurrence (BCR) rate was defined as two consecutive PSA levels of > 0.2 ng/mL after RARP. Outcomes of the pentafecta were complications and positive surgical margins combined with the trifecta outcomes.
RESULTS
Trifecta was achieved in 4.6, 5.6, 8.1, and 9.6% of all patients at 3, 6, 9, and 12 months, respectively. Pentafecta rates were 2.3, 3.0, 5.1, and 6.1%, respectively. Trifecta rates in the nerve-sparing (NS) group were 12.5, 12.7, 18.9, and 23.6%, respectively. The BCR-free rates maintained a high level and were 94.4, 93.9, 93.9, and 90.9%, respectively. Continence rates were improved to 55.2, 75.5, 81.6, and 85.0%, while the potency rate was extremely low at 7.5, 7.8, 9.8, and 10.9%. Even in the NS group, potency rates remained low at 18.1, 18.6, 21.9, and 26.1%, respectively.
CONCLUSION
This longitudinal analysis of trifecta outcomes may be beneficial and should be used when counseling patients with clinically localized PCa.
目的
使用机器人辅助腹腔镜前列腺根治术（RARP）分析三位一体结局（控尿、勃起功能和癌症控制）的纵向变化。
方法
我们前瞻性地获得了由一位外科医生进行的 291 例 RARP 患者的 1 年纵向扩展前列腺癌指数综合评分（EPIC）数据（术前和 RARP 后 3、6、9 和 12 个月）。控尿定义为使用“零或一个尿垫”。勃起功能定义为获得和维持足以进行性活动或性交的满意勃起的能力。控尿和勃起功能通过患者报告的结果（EPIC 问题 5 和 18）进行主观判断。生化复发（BCR）率定义为 RARP 后两次连续 PSA 水平均>0.2ng/mL。五重奏的结果是并发症和阳性切缘与三位一体结局相结合。
结果
所有患者在 3、6、9 和 12 个月时分别达到三位一体结局的比例为 4.6%、5.6%、8.1%和 9.6%。五重奏的比例分别为 2.3%、3.0%、5.1%和 6.1%。在神经保留（NS）组中，达到三位一体结局的比例分别为 12.5%、12.7%、18.9%和 23.6%。无 BCR 率保持在较高水平，分别为 94.4%、93.9%、93.9%和 90.9%。控尿率提高至 55.2%、75.5%、81.6%和 85.0%，而勃起功能的比例极低，分别为 7.5%、7.8%、9.8%和 10.9%。即使在 NS 组中，勃起功能的比例也分别为 18.1%、18.6%、21.9%和 26.1%。
结论
本研究对三位一体结局的纵向分析可能有益，在为临床局限性前列腺癌患者提供咨询时应加以考虑。
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