Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126, Verona, Italy.
Department of Urology, Vito Fazzi Hospital, Lecce, Italy.
Aging Clin Exp Res. 2022 Nov;34(11):2857-2863. doi: 10.1007/s40520-022-02213-w. Epub 2022 Aug 17.
Although advanced age doesn't seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center.
1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases.
243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7-42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844-15.237; p = 0.002) compared to the younger patients.
Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.
尽管年龄增长似乎不会影响机器人辅助根治性前列腺切除术（RARP）后的肿瘤学结果，但由于高危疾病发病率较高，老年患者前列腺癌（PCa）相关死亡的发生率更高。年龄增长对 RARP 后肿瘤学结果的潜在不利影响仍然是一个悬而未决的问题。我们旨在评估单一三级中心中年龄超过 69 岁的 PCa 患者的肿瘤学结果。
1143 例临床局限性 PCa 患者接受 RARP 治疗，时间从 2013 年 1 月至 2020 年 10 月。对 901 例具有可随访资料的患者进行了分析。年龄≥70 岁的患者被认为是老年患者。不良病理学包括 ISUP 分级组>2、精囊和盆腔淋巴结侵犯。疾病进展定义为生化和/或局部复发和/或远处转移。
243 例（27%）被归类为老年患者（中位年龄 72 岁）。中位（IQR）随访时间为 40.4（38.7-42.2）个月。159 例（17.6%）发生疾病进展。与年轻患者相比，老年患者更可能属于 EAU 高危类别，具有不良病理学特征，并在手术后出现疾病进展（HR=5.300；95%CI 1.844-15.237；p=0.002）。
适合接受 RARP 治疗的老年患者更有可能属于 EAU 高危类别，且具有不良病理学特征，这些特征是疾病进展的独立预测因素。在这些不良类别中评估时，年龄增长会对肿瘤学结果产生不利影响。因此，属于 EAU 高危类别的老年患者应被告知手术后疾病进展的风险增加。
