Yang Ming, Hong Tianxiao, Ji Hao, Zhao Chaoran, Wang Yamin, Wang Shangqian, Bao Meiling, Li Pengchao
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Department of Urology, The Second Affiliated Hospital of Nanjing, University of Chinese Medicine, Nanjing, 210017, China.
World J Urol. 2025 Aug 31;43(1):520. doi: 10.1007/s00345-025-05794-z.
To evaluate the oncological outcomes and continence recovery of neoadjuvant hormonal therapy (NHT) before robot-assisted laparoscopic radical prostatectomy (RARP) with neurovascular bundle (NVB) preservation in patients with locally advanced prostate cancer (LAPC).
Of the 576 patients with LAPC who underwent RARP during January 2016-March 2024, those who received NHT before RARP with NVB preservation (NVB-RARP) were propensity score (PS)-matched with those undergoing RARP without NVB preservation (NNVB-RARP) based on preoperative and histological characteristics. Clinical and biochemical recurrence results were evaluated post-surgically, and postoperative continence was analyzed in the two groups using Kaplan-Meier curves.
After PS matching, each group was matched with 77 patients. When compared with the NNVB-RARP group, the NVB-RARP group did not show any significant difference in the operation time (102.72 ± 11.64 min vs.105.05 ± 16.73 min, p = 0.319), postoperative hospitalization time (5.01 ± 0.80 d vs. 5.21 ± 1.13 d, p = 0.248), intraoperative bleeding (158.43 ± 13.76 mL vs. 161.23 ± 15.15 mL, p = 0.232), pathologic tumor stage (≤ pT2) (53.25% vs. 50.65%, p = 0.747), lymph node status (N1) (27.27% vs. 36.36%, p = 0.226), pathological Gleason score (≥ 8) (81.82% vs. 76.62%, p = 0.427), positive surgical margin (15.58% vs. 20.78%, p = 0.403), or complications (9.10% vs.11.69%, p = 0.597). The NVB-RARP group demonstrated significantly faster continence recovery than the NNVB-RARP group (recovery rates: 1 month 42.86% vs. 16.88%, p < 0.001, 3 months 62.34% vs. 36.36%, p = 0.001, and 12 months 83.12% vs. 66.23%, p = 0.016).
The present findings suggest that NHT before RARP with NVB preservation may enhance continence recovery without compromising the oncological outcomes in patients with LAPC.
评估新辅助激素治疗（NHT）联合保留神经血管束（NVB）的机器人辅助腹腔镜根治性前列腺切除术（RARP）对局部晚期前列腺癌（LAPC）患者肿瘤学结局和控尿功能恢复情况的影响。
选取2016年1月至2024年3月期间接受RARP手术的576例LAPC患者，根据术前和组织学特征，将术前接受NHT联合保留NVB的RARP（NVB-RARP）患者与未保留NVB的RARP（NNVB-RARP）患者进行倾向评分（PS）匹配。术后评估临床和生化复发结果，并采用Kaplan-Meier曲线分析两组患者术后的控尿情况。
PS匹配后，每组各有77例患者。与NNVB-RARP组相比，NVB-RARP组在手术时间（102.72±11.64分钟 vs.105.05±16.73分钟，p = 0.319）、术后住院时间（5.01±0.80天 vs. 5.21±1.13天，p = 0.248）、术中出血量（158.43±13.76毫升 vs. 161.23±15.15毫升，p = 0.232）、病理肿瘤分期（≤pT2）（53.25% vs. 50.65%，p = 0.747）、淋巴结状态（N1）（27.27% vs. 36.36%，p = 0.226）、病理Gleason评分（≥8）（ 81.82% vs. 76.62%，p = 0.427）、手术切缘阳性率（15.58% vs. 20. 78%，p = 0.403）或并发症发生率（9.10% vs.11.69%，p = 0.597）方面均无显著差异。NVB-RARP组的控尿功能恢复明显快于NNVB-RARP组（恢复率：1个月时为42.86% vs. 16.88%，p < 0.001；3个月时为62.34% vs. 36.36%，p = 0.001；12个月时为83.12% vs. 66.23%，p = 0.016）。
本研究结果表明，对于LAPC患者，RARP术前进行NHT联合保留NVB可促进控尿功能恢复，且不影响肿瘤学结局。
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