Abstract

Purpose

Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse.

Methods

In the current retrospective analysis, inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p < 0.05).

Results

Open retropubic prostatectomy and RARP cohorts were well balanced. General HRQOL was significantly higher for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not at the remaining follow-up time points. There were no significant differences for the remaining QLQ-C30 functioning and symptom scores. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as a marginally independent predictor for lower ratios of good general HRQOL after 3 months (OR 0.464, 95% CI 0.215–0.999; p = 0.050) without any differences at the remaining time points.

Conclusions

The current study addresses various HRQOL outcomes over a postoperative period of up to 2 years in a homogenous propensity score-matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3 months postoperatively.

中文翻译：

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中低危前列腺癌患者接受开放式机器人辅助根治性前列腺切除术后与健康相关的生活质量：倾向评分匹配分析

摘要

目的

机器人辅助根治性前列腺切除术（RARP）的引入彻底改变了器官受限前列腺癌（PCa）的治疗领域。然而，针对RARP和耻骨后前列腺切除术（ORP）后与健康相关的生活质量（HRQOL）的比较分析很少。

方法

在当前的回顾性分析中，纳入标准包括PSA≤10 ng / ml，≤pT2c，ISUP≤3，年龄≤65岁和术前自控。 术前，术后3个月，12个月和24个月，根据倾向评分匹配的患者队列[ n = 418（ORP：209，RARP：209）]进行了前瞻性评估，并根据经过验证的问卷（EORTC QLQ-C30）对HRQOL进行了评估。 。根据先前公布的临界值，主要终点是良好的一般HRQOL。通过IIEF-5测量勃起功能，通过ICIQ-SF问卷测量尿失禁。多变量分析包括二元逻辑回归模型（p  <0.05）。

结果

开放性耻骨后前列腺切除术和RARP队列很平衡。3个月后，ORP的总体HRQOL明显高于RARP（70.1 vs. 61.6，p  = 0.001），但在其余的随访时间点没有。其余QLQ-C30的功能和症状评分无明显差异。在对IIEF-5和ICIQ-SF得分以及外科医生经验进行分层的多变量分析中，可以将RARP确认为3个月后良好的一般HRQOL较低的比率的边缘独立预测因子（或0.464，95％CI 0.215-0.999；p  = 0.050 ）在其余时间点没有任何差异。

结论

目前的研究针对均质倾向得分匹配的当代人群在长达2年的术后期间解决了各种HRQOL结果。与术后3个月的RARP相比，ORP的总体HRQOL结局略好。