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机器人辅助根治性前列腺切除术后的手术等待时间与肿瘤学或心理社会结局无关。

Surgical Wait Time Is Not Associated With Oncological or Psychosocial Outcomes After Robotic Radical Prostatectomy.

作者信息

Cotte Juliette, Leslie Scott, Bird Jacob, Treacy Patrick-Julien, Hirst Nicholas, Alexander Kate, Steffens Daniel, Thanigasalam Ruban

机构信息

Department of Urology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Department of Urology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.

出版信息

Prostate Cancer. 2025 Jul 29;2025:4314397. doi: 10.1155/proc/4314397. eCollection 2025.

Abstract

Prostate cancer (PCa) is a prevalent malignancy in men, with increasing incidence and longer wait times for curative surgery, particularly in public health systems. While the impact of surgical wait time (SWT) on oncological outcomes in PCa remains controversial, its influence on patient-reported outcomes has not been thoroughly evaluated. To assess the impact of SWT on both oncological and psychological outcomes in patients undergoing robot-assisted radical prostatectomy (RARP) for preoperative ISUP grade 2 and 3 PCa. This retrospective single-center study included patients who underwent RARP for intermediate risk localized PCa between April 2016 and August 2024. Patients were stratified into two groups based on SWT: < 6 months vs. ≥ 6 months. The primary outcome was recurrence-free survival (RFS) for all patients. Secondary outcomes included RFS in a high-risk subgroup defined by pathological features (pT3 stage, seminal vesicle invasion, extracapsular extension, and positive surgical margins), as well as a comparison of functional outcomes between the two groups. Patient-reported outcomes were evaluated using SF-36 (mental and physical components) and the Decision Regret Scale (DRS) at 6 weeks, 3 months, 6 months, and 1 year. Statistical analyses included Kaplan-Meier survival estimates, Cox proportional hazard models, and comparative tests with < 0.05 considered significant. 218 patients have been included. RFS did not significantly differ between groups (=0.98), including among high-risk patients (=1.00). No significant differences were found in extraprostatic extension, seminal vesicle invasion, positive surgical margins, or ISUP upgrading between groups. Similarly, changes in both SF-36 physical and mental and DRS scores showed no statistically significant differences at all time points. In this cohort of patients with intermediate-risk PCa, SWT beyond 6 months did not adversely affect oncological or health-related quality of life outcomes.

摘要

前列腺癌(PCa)是男性中一种常见的恶性肿瘤,其发病率不断上升,根治性手术的等待时间也越来越长,尤其是在公共卫生系统中。虽然手术等待时间(SWT)对PCa肿瘤学结局的影响仍存在争议,但其对患者报告结局的影响尚未得到充分评估。为了评估SWT对接受机器人辅助根治性前列腺切除术(RARP)治疗术前ISUP 2级和3级PCa患者的肿瘤学和心理结局的影响。这项回顾性单中心研究纳入了2016年4月至2024年8月期间因中度风险局限性PCa接受RARP的患者。根据SWT将患者分为两组:<6个月与≥6个月。所有患者的主要结局是无复发生存期(RFS)。次要结局包括由病理特征(pT3期、精囊侵犯、包膜外扩展和手术切缘阳性)定义的高危亚组中的RFS,以及两组之间功能结局的比较。在6周、3个月、6个月和1年时,使用SF-36(心理和身体成分)和决策后悔量表(DRS)评估患者报告的结局。统计分析包括Kaplan-Meier生存估计、Cox比例风险模型,以及以<0.05为显著的比较检验。共纳入218例患者。两组之间的RFS无显著差异(=0.98),高危患者中也是如此(=1.00)。两组之间在前列腺外扩展、精囊侵犯、手术切缘阳性或ISUP升级方面均未发现显著差异。同样,SF-36身体和心理评分以及DRS评分在所有时间点的变化均无统计学显著差异。在这组中度风险PCa患者中,超过6个月的SWT对肿瘤学或与健康相关的生活质量结局没有不利影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51a2/12324907/acee965500f2/PC2025-4314397.001.jpg

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