机器人辅助根治性前列腺切除术在健康老年患者与标准人群中的比较：临床特征、手术、肿瘤学和功能结局。
Robot assisted radical prostatectomy in fit older patients compared to a standard population: Clinical characteristics, surgical, oncological and functional outcomes.
机构信息
Università degli Studi di Milano, Urology Department - Istituto Europeo di Oncologia, Milano, Italy; Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France.
Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France.
出版信息
Prog Urol. 2023 Apr;33(5):272-278. doi: 10.1016/j.purol.2023.01.005. Epub 2023 Feb 8.
INTRODUCTION
To compare robotic assisted radical prostatectomy (RARP) in well-selected older patients with clinically localized prostate cancer, compared to a younger population. Primary endpoint was perioperative outcomes comparison and secondary endpoint were oncological and functional outcomes comparison to a younger population.
METHODS
Single tertiary center cohort of consecutive patients treated with RARP (2017-2020) with retrospective analysis. Patients were classified by age in two groups: <75: control group (CG) and ≥75: study group (SG). Patients aged ≥75 had a comprehensive geriatric assessment (CGA) and only patients classified Balducci ≤2 were admitted to surgery.
RESULTS
Two hundred and sixty-nine patients were included, 56 in SG and 213 in CG. Median follow-up was 9.8 months. Univariate analysis showed no statistically significant (SS) difference between the groups for patients' characteristics (PSA, digital rectal examination -DRE- and biopsy Gleason Score), perioperative data (operative time, hospitalization length, transfusions rate, immediate complications, Clavien-Dindo complications, 30-days re-interventions and 30-days re-hospitalisation), oncological (TNM, margins, extraprostatic extension, postoperative PSA, BCR, metastases, overall survival -OS- and cancer specific survival -CSS-) and functional outcomes. Median perioperative blood loss was lower in the SG: 200.00 cc IQR [100.00, 300.00] vs 200.00cc IQR [100.00, 400.00] in the CG (P<0.05). A multivariate regression considering age>75, DRE, GS, PSA, cardiovascular history and diabetes showed none of variables associated with early BCR. Limitations are retrospective design, small number of patients and short follow-up.
CONCLUSIONS
RARP shows similar perioperative, oncologic and functional outcomes for older patients selected by a CGA when compared to younger patients. The SG shows a minor perioperative bleeding.
LEVEL OF EVIDENCE
IV.
简介
本研究旨在比较机器人辅助根治性前列腺切除术（RARP）治疗选择良好的老年局限性前列腺癌患者与年轻患者的围手术期结局，并进一步比较两组的肿瘤学和功能结局。主要终点为围手术期结局比较，次要终点为与年轻患者相比的肿瘤学和功能结局比较。
方法
对 2017 年至 2020 年在单中心接受 RARP 治疗的连续患者进行回顾性队列研究。患者按年龄分为两组：<75 岁为对照组（CG），≥75 岁为研究组（SG）。≥75 岁的患者接受全面老年评估（CGA），仅将 Balducci 评分≤2 的患者纳入手术。
结果
共纳入 269 例患者，SG 组 56 例，CG 组 213 例。中位随访时间为 9.8 个月。单因素分析显示，两组患者的特征（PSA、直肠指检-DRE-和活检 Gleason 评分）、围手术期数据（手术时间、住院时间、输血率、即刻并发症、Clavien-Dindo 并发症、30 天再干预和 30 天再入院）、肿瘤学（TNM、切缘、前列腺外延伸、术后 PSA、生化复发、远处转移、总生存和癌症特异性生存）和功能结局均无统计学显著差异。SG 组围手术期失血量中位数较低：200.00cc IQR [100.00, 300.00] vs CG 组 200.00cc IQR [100.00, 400.00]（P<0.05）。多因素回归分析考虑年龄>75 岁、DRE、GS、PSA、心血管病史和糖尿病，无变量与早期生化复发相关。局限性在于回顾性设计、患者数量少和随访时间短。
结论
在经过 CGA 选择的老年患者中，RARP 的围手术期、肿瘤学和功能结局与年轻患者相似。SG 组围手术期出血量较少。
证据等级
IV 级。
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