Falkenbach Fabian, Di Bello Francesco, Rodriguez Peñaranda Natali, Longoni Mattia, Marmiroli Andrea, Le Quynh Chi, Catanzaro Calogero, Nicolazzini Michele, Tian Zhe, Goyal Jordan A, Longo Nicola, Puliatti Stefano, Schiavina Riccardo, Palumbo Carlotta, Musi Gennaro, Chun Felix K H, Briganti Alberto, Saad Fred, Shariat Shahrokh F, Mehring Gisa, Budäus Lars, Graefen Markus, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC H2X 0A9, Canada.
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
Cancers (Basel). 2025 Mar 31;17(7):1193. doi: 10.3390/cancers17071193.
: Adverse in-hospital outcomes at radical prostatectomy have not been specifically addressed in young patients aged 40-49 years (quadragenarians). Additionally, no comparison between robot-assisted (RARP) vs. open radical prostatectomy (ORP) has been reported in this population. : Descriptive analyses, propensity score matching (PSM), and multivariable logistic/Poisson regression models addressed quadragenarians undergoing RARP or ORP within the National Inpatient Sample (2009-2019). : Of 5426 quadragenarians, 4083 (75.2%) and 1343 (24.8%) underwent RARP and ORP, respectively. The proportion of RARP increased from 68.1 to 84.5% (2009-2019, EAPC: +2.8%, < 0.001). Adverse in-hospital outcomes after RARP were invariably lower than those after ORP. Specifically, the rates of overall complications (7.8 vs. 13.4%, Δ -5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Δ -5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Δ -18.1%, OR: 0.32) were lower after RARP than after ORP (all < 0.001). After additional one-to-one PSM between ORP and RARP patients, virtually the same results were reported (overall complications: 7.0 vs. 13.4%, Δ -6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Δ -4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Δ -17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Δ USD +6850, IRR: 1.18; < 0.001). : Quadragenarians exhibited a more favorable adverse in-hospital outcome profile after RARP vs. ORP. These advantages are offset by a small, albeit significant, increase in total hospital charges.
40 - 49岁的年轻患者（四十多岁的人）在根治性前列腺切除术中的不良院内结局尚未得到专门研究。此外，该人群中机器人辅助根治性前列腺切除术（RARP）与开放性根治性前列腺切除术（ORP）之间的比较尚无报道。描述性分析、倾向评分匹配（PSM）以及多变量逻辑/泊松回归模型研究了国家住院患者样本（2009 - 2019年）中接受RARP或ORP的四十多岁患者。在5426名四十多岁的患者中，分别有4083名（75.2%）和1343名（24.8%）接受了RARP和ORP。RARP的比例从68.1%增加到84.5%（2009 - 2019年，EAPC：+2.8%，P < 0.001）。RARP后的不良院内结局始终低于ORP后的结局。具体而言，RARP后总体并发症发生率（7.8%对13.4%，差值 -5.6%，多变量优势比（OR）：0.54）、输血率（1.2%对6.3%，差值 -5.1%，OR：0.21）以及住院时间（LOS）> 2天的比例（10.6%对28.7%，差值 -18.1%，OR：0.32）均低于ORP后（均P < 0.001）。在ORP和RARP患者之间进行额外的一对一PSM后，报告了几乎相同的结果（总体并发症：7.0%对13.4%，差值 -6.4%，OR：0.49；输血率：1.5%对6.3%，差值 -4.8%，OR：0.23；LOS > 2天：10.9%对28.7%，差值 -17.8%，OR：0.30）。相反，使用RARP导致总住院费用更高（43,690美元对36,840美元，差值 +6850美元，内部收益率：1.18；P < 0.001）。与ORP相比，四十多岁的患者在RARP后表现出更有利的不良院内结局特征。尽管总住院费用有小幅但显著的增加，但这些优势得以抵消。
