Nathan Arjun, Gao Chuanyu, Light Alexander, Alexander Cameron, Chan Vinson, Gallagher Kevin, Khadhouri Sinan, Byrnes Kevin G, Ng Michael, Walters Michael, Hughes Terry, Perry Rita J, Okoth Kelvin, Magill Laura, Pinkney Thomas, Zhang Yuhao, Blackmur James, Etchill Eric, Tang Stanley, García Escudero Damián, McNeill Alan, Narahari Krishna, Stewart Grant D, Kasivisvanathan Veeru
Division of Surgery and Interventional Sciences University College London London UK.
British Urology Researchers in Surgical Training (BURST) Research Collaborative London UK.
BJUI Compass. 2024 Oct 17;5(12):1314-1323. doi: 10.1002/bco2.433. eCollection 2024 Dec.
The objective of this study is to compare the early oncological outcomes of delayed (>90 days) versus scheduled (≤90 days) radical prostatectomy (RP).
Patients with prostate cancer due to undergo surgery between March 2020 and June 2020 who were enrolled in the COVIDSurg-Cancer international, observational study were prospectively followed up for 1 year. Time to surgery was defined as the difference between the operation date and the multi-disciplinary team decision to offer surgery. The primary outcome was the positive surgical margin (PSM) rate. Biochemical recurrence (BCR), upgradation and upstaging were secondary oncological outcomes. The Independent -test and Mann Whitney test were used to compare means between groups and regression models and were used to investigate factors associated with the primary outcome.
Four hundred seventy-six (78.7%) patients underwent RP from 605 that were eligible. Three hundred seven (64.5%) patients underwent scheduled RP, and 169 (35.5%) underwent delayed RP. A small proportion of men ( = 35, 6.8%) did not undergo RP within the 1-year follow-up period. More men with high-risk disease (72.8%) underwent scheduled RP compared to men with intermediate-risk disease (60.2%) ( < 0.05). There was no statistically significant difference in the PSM rate between the two groups ( = 0.512). Delay in surgery was not associated with an increased PSM or BCR on univariable or multivariable analyses. There was statistically significantly greater upstaging ( < 0.05) in the delayed group but no difference in upgradation.
High-risk men were prioritised for surgery during the COVID-19 pandemic. Our prospective data support previous retrospective, cancer-registry evidence suggesting no adverse oncological impact after delaying RP across all risk groups. Our study is limited by the short follow-up period, and therefore, longer term conclusions cannot be drawn.
本研究的目的是比较延迟（>90天）与计划（≤90天）根治性前列腺切除术（RP）的早期肿瘤学结局。
2020年3月至2020年6月期间因手术入组COVIDSurg-Cancer国际观察性研究的前列腺癌患者接受了为期1年的前瞻性随访。手术时间定义为手术日期与多学科团队决定进行手术之间的差值。主要结局是手术切缘阳性（PSM）率。生化复发（BCR）、分级升级和分期升级是次要肿瘤学结局。采用独立样本t检验和曼-惠特尼检验比较组间均值，并使用回归模型研究与主要结局相关的因素。
605例符合条件的患者中，476例（78.7%）接受了RP。307例（64.5%）患者接受了计划RP，169例（35.5%）接受了延迟RP。一小部分男性（n = 35，6.8%）在1年随访期内未接受RP。与中度风险疾病男性（60.2%）相比，更多高风险疾病男性（72.8%）接受了计划RP（P < 0.05）。两组间PSM率无统计学显著差异（P = 0.512）。单变量或多变量分析显示，手术延迟与PSM或BCR增加无关。延迟组分期升级在统计学上显著更高（P < 0.05），但分级升级无差异。
在COVID-19大流行期间，高风险男性被优先安排手术。我们的前瞻性数据支持先前的回顾性癌症登记证据，表明在所有风险组中延迟RP后无不良肿瘤学影响。我们的研究受限于随访期较短，因此无法得出长期结论。
