Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
Sci Rep. 2023 Sep 22;13(1):15835. doi: 10.1038/s41598-023-43092-z.
Pentafecta (continence, potency, cancer control, free surgical margins, and no complications) is an important outcome of prostatectomy. Our objective was to assess the pentafecta achievement between nerve-spring and non-nerve-sparing robot-assisted radical prostatectomy (RARP) in a large single-center cohort. The study included 1674 patients treated with RARP between August 2009 and November 2022 to assess the clinical outcomes. Cox regression analyses were performed to evaluate the prognostic significance of RARP for pentafecta achievement, and 1:1 propensity score matching (PSM) was performed between the nerve-sparing and non-nerve-sparing to test the validity of the results. Pentafecta definition included continence, which was defined as the use of zero pads; potency, which was defined as the ability to achieve and maintain satisfactory erections or ones firm enough for sexual activity and sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels > 0.2 ng/mL after RARP; 90-day Clavien-Dindo complications ≤ 3a; and a negative surgical pathologic margin. The median follow-up period was 61.3 months (IQR 6-159 months). A multivariate Cox regression analysis demonstrated that pentafecta achievement was significantly associated with nerve-sparing (NS) approach (1188 patients) (OR 4.16; 95% CI 2.51-6.9), p < 0.001), unilateral nerve preservation (983 patients) (OR 3.83; 95% CI 2.31-6.37, p < 0.001) and bilateral nerve preservation (205 patients) (OR 7.43; 95% CI 4.14-13.36, p < 0.001). After propensity matching, pentafecta achievement rates in the NS (476 patients) and non-NS (476 patients) groups were 72 (15.1%) and 19 (4%), respectively. (p < 0.001). NS in RARP offers a superior advantage in pentafecta achievement compared with non-NS RARP. This validation study provides the pentafecta outcome after RARP associated with nerve-sparing in clinical practice.
五重奏（控尿、勃起功能、肿瘤控制、无切缘阳性和无并发症）是前列腺切除术的一个重要结果。我们的目的是在一个大型单中心队列中评估神经保留和非神经保留机器人辅助前列腺切除术（RARP）之间的五重奏实现情况。该研究纳入了 2009 年 8 月至 2022 年 11 月期间接受 RARP 治疗的 1674 例患者，以评估临床结果。使用 Cox 回归分析评估 RARP 对五重奏实现的预后意义，并对神经保留和非神经保留组进行 1:1 倾向评分匹配（PSM）以验证结果的有效性。五重奏定义包括控尿，定义为使用零垫；勃起功能，定义为能够实现和维持满意的勃起或足够坚硬以进行性行为和性交。生化复发率定义为 RARP 后连续两次 PSA 水平>0.2ng/ml；90 天 Clavien-Dindo 并发症≤3a；以及阴性手术病理切缘。中位随访时间为 61.3 个月（IQR 6-159 个月）。多变量 Cox 回归分析表明，五重奏的实现与神经保留（NS）方法（1188 例患者）显著相关（OR 4.16；95%CI 2.51-6.9），p<0.001）、单侧神经保留（983 例患者）（OR 3.83；95%CI 2.31-6.37，p<0.001）和双侧神经保留（205 例患者）（OR 7.43；95%CI 4.14-13.36，p<0.001）。在倾向评分匹配后，NS 组（476 例）和非 NS 组（476 例）的五重奏实现率分别为 72（15.1%）和 19（4%），（p<0.001）。RARP 中的 NS 与非 NS RARP 相比，在五重奏实现方面具有明显优势。这项验证研究提供了神经保留与临床实践中 RARP 相关的五重奏结果。
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