Jung Gyoohwan, Kim Jung Kwon, Oh Jong Jin, Lee Sangchul, Byun Seok-Soo, Hong Sung Kyu, Lee Hakmin
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea.
Prostate Int. 2023 Sep;11(3):134-138. doi: 10.1016/j.prnil.2022.12.001. Epub 2022 Dec 17.
We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer.
We analyzed 3,859 patients who had undergone RARP and PGA using HIFU. According to the propensity score for each treatment, 137 patients after PGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method.
The matched cohort comprised 685 subjects (RARP, 548; PGA, 137), with a median follow-up period of 22 months. Treatment failures were identified in 13.9% and 9.1% of patients in the PGA and RARP groups, respectively, after a median follow-up of 36 months postoperatively. Kaplan-Meier analyses revealed significantly longer failure-free ( < 0.001) and salvage-free survival ( = 0.003) in the RARP group than in the PGA group. There was no significant difference in the postoperative urinary symptom score ( = 0.748), but the postoperative erectile function score was significantly higher in the PGA group ( < 0.001). The rate of urinary incontinence (any pad) was significantly lower in the PGA group than that in the RARP group ( < 0.001). Postoperative complications were more frequent in the PGA group ( = 0.003); however, there was no significant difference in high-grade complications (≥3) ( = 0.467).
PGA using HIFU showed statistically inferior oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding postoperative incontinence and erectile dysfunction were more favorable in the PGA group.
我们比较了机器人辅助根治性前列腺切除术（RARP）和高强度聚焦超声（HIFU）局部前列腺癌部分腺体消融术（PGA）的临床结果。
我们分析了3859例行RARP和HIFU-PGA的患者。根据每种治疗的倾向评分，采用最近邻法按1:4的比例将137例PGA术后患者与3722例RARP术后患者进行匹配。
匹配队列包括685名受试者（RARP组548名，PGA组137名），中位随访期为22个月。术后中位随访36个月后，PGA组和RARP组分别有13.9%和9.1%的患者出现治疗失败。Kaplan-Meier分析显示，RARP组的无失败生存期（P<0.001）和无需挽救生存期（P=0.003）均显著长于PGA组。术后尿路症状评分无显著差异（P=0.748），但PGA组术后勃起功能评分显著更高（P<0.001）。PGA组尿失禁（使用任何尿垫）发生率显著低于RARP组（P<0.001）。PGA组术后并发症更常见（P=0.003）；然而，高级别并发症（≥3级）无显著差异（P=0.467）。
与RARP相比，HIFU-PGA在无失败生存期和无需挽救生存期方面的肿瘤学结果在统计学上较差。然而，PGA组在术后尿失禁和勃起功能障碍方面的功能结果更优。
