高风险前列腺癌患者行保留神经的根治性前列腺切除术（NSRP）后的肿瘤学结果与标准非 NSRP 相当：一项纵向长期倾向匹配的单中心研究。

Oncological outcomes after attempted nerve-sparing radical prostatectomy (NSRP) in patients with high-risk prostate cancer are comparable to standard non-NSRP: a longitudinal long-term propensity-matched single-centre study.

机构信息

Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten and Bürgerspital Solothurn, Biberist, Switzerland.

出版信息

BJU Int. 2024 Jan;133(1):53-62. doi: 10.1111/bju.16126. Epub 2023 Aug 21.

DOI:10.1111/bju.16126

PMID:37548822

Abstract

OBJECTIVE

To assess the long-term safety of nerve-sparing radical prostatectomy (NSRP) in men with high-risk prostate cancer (PCa) by comparing survival outcomes, disease recurrence, the need for additional therapy, and perioperative outcomes of patients undergoing NSRP to those having non-NSRP.

PATIENTS AND METHODS

We included consecutive patients at a single, academic centre who underwent open RP for high-risk PCa, defined as preoperative prostate-specific antigen level of > 20 ng/mL and/or postoperative International Society of Urological Pathology Grade Group 4 or 5 (i.e., Gleason score ≥ 8) and/or ≥pT3 and/or pN1 assessing the RP and lymph node specimen. We calculated a propensity score and used inverse probability of treatment weighting to match baseline characteristics of patients with high-risk PCa who underwent NSRP vs non-NSRP. We analysed oncological outcome as time-to-event and calculated hazard ratios (HRs).

RESULTS

A total of 726 patients were included in this analysis of which 84% (n = 609) underwent NSRP. There was no evidence for the positive surgical margin rate being different between the NSRP and non-NSRP groups (47% vs 49%, P = 0.64). Likewise, there was no evidence for the need for postoperative radiotherapy being different in men who underwent NSRP from those who underwent non-NSRP (HR 0.78, 95% confidence interval [CI] 0.53-1.15). NSRP did not impact the risk of any recurrence (HR 0.99, 95% CI 0.73-1.34, P = 0.09) and there was no evidence for survival being different in men who underwent NSRP to those who underwent non-NSRP (HR 0.65, 95% CI 0.39-1.08). There was also no evidence for the cancer-specific survival (HR 0.56, 95% CI 0.29-1.11) or progression-free survival (HR 0.99, 95% CI 0.73-1.34) being different between the groups.

CONCLUSION

In patients with high-risk PCa, NSRP can be attempted without compromising long-term oncological outcomes provided a comprehensive assessment of objective (e.g., T Stage) and subjective (e.g., intraoperative appraisal of tissue planes) criteria are conducted.

摘要

目的

通过比较行保留神经的根治性前列腺切除术（NSRP）和非保留神经的根治性前列腺切除术（非 NSRP）患者的生存结局、疾病复发、辅助治疗需求和围手术期结局，评估高风险前列腺癌（PCa）患者行 NSRP 的长期安全性。

方法

我们纳入了在单中心接受开放性根治性前列腺切除术治疗高风险 PCa 的连续患者，高风险 PCa 的定义为术前前列腺特异性抗原水平＞20ng/ml 和/或术后国际泌尿病理学会（ISUP）分级分组 4 或 5（即 Gleason 评分≥8）和/或≥pT3 和/或 pN1 评估前列腺和淋巴结标本。我们计算了倾向评分并使用逆概率治疗加权法来匹配行 NSRP 和非 NSRP 的高风险 PCa 患者的基线特征。我们将肿瘤学结局作为时间依赖性进行分析，并计算了风险比（HRs）。

结果

本分析共纳入了 726 例患者，其中 84%（n=609）行 NSRP。NSRP 组和非 NSRP 组的阳性切缘率无显著差异（47% vs 49%，P=0.64）。同样，行 NSRP 的患者与行非 NSRP 的患者在术后需要放疗的比例也无显著差异（HR 0.78，95%置信区间 [CI] 0.53-1.15）。NSRP 并不影响任何复发的风险（HR 0.99，95% CI 0.73-1.34，P=0.09），也不影响两组患者的生存率（HR 0.65，95% CI 0.39-1.08）。两组患者的癌症特异性生存率（HR 0.56，95% CI 0.29-1.11）和无进展生存率（HR 0.99，95% CI 0.73-1.34）也无显著差异。