分析中国队列中腹腔镜和机器人辅助手术前新辅助激素治疗(NHT)治疗局限性高危前列腺癌的围手术期结果。
回顾性分析2019年1月至2021年6月在我院行根治性前列腺切除术(RP)的385例局限性高危前列腺癌患者的临床资料。其中术前NHT患者168例,单纯手术患者217例。比较上述两组的临床特点,腹腔镜RP(LRP)队列(n=234)和机器人辅助腹腔镜前列腺癌根治术(RALP)队列(n=151),分别。
在整个队列中,与对照组相比,NHT组手术时间较短,减少失血,较低的阳性手术切缘率,术后Gleason评分(GS)下降比例较高(p<0.05)。然而,住院时间无显著差异,生化复发,漏尿,尿失禁,或前列腺特异性抗原(PSA)无进展生存期(p>0.05)。在LRP队列中,发现NHT组的手术时间也较短,减少失血,较低的阳性手术切缘率,手术后GS降级的比例更高,尿控恢复快于对照组(p<0.05)。住院时间没有明显差异,生化复发,尿漏,或PSA无进展生存期。然而,在RALP队列中,NHT组术后GS分级与对照组比较差异有统计学意义(p<0.05)。在整个队列中,多项分析表明,初始PSA水平,活检时的GS,临床T分期,淋巴结浸润,使用NHT,和手术方法与手术切缘阳性显着相关(p<0.05),而NHT与生化复发无关(p>0.05)。
NHT可以降低手术难度,降低手术切缘阳性率,并有助于LRP术后高危前列腺癌患者的短期泌尿控制恢复。然而,对于接受RALP治疗的高危PCa患者,我们没有NHT获益的证据.对于这些患者来说,手术可以尽早进行。
To analyze the perioperative outcomes of neoadjuvant hormone therapy (NHT) before laparoscopic and robot-assisted surgery for localized high-risk prostate cancer in a Chinese cohort.
The clinical data of 385 patients with localized high-risk prostate cancer who underwent radical prostatectomy (RP) in our hospital from January 2019 to June 2021 were analyzed retrospectively, including 168 patients with preoperative NHT and 217 patients with simple surgery. Clinical characteristics were compared in the above two groups, the laparoscopic RP (LRP) cohort (n = 234) and the robot-assisted laparoscopic radical prostatectomy (RALP) cohort (n = 151), respectively.
In the overall cohort, compared with the control group, the NHT group had a shorter operative time, less blood loss, a lower positive surgical margin rate, and a higher proportion of Gleason score (GS) downgrading after the operation (p < 0.05). However, there was no significant difference in hospitalization time, biochemical recurrence, urine leakage, urinary continence, or prostate-specific antigen (PSA) progression-free survival (p > 0.05). In the LRP cohort, it was found that the NHT group also had shorter operative time, less blood loss, lower positive surgical margin rate, a higher proportion of GS downgrading after the operation, and faster recovery of urinary control than the control group (p < 0.05). There was no marked difference in hospitalization time, biochemical recurrence, urinary leakage, or PSA progression-free survival. However, in the RALP cohort, the NHT group had a significant difference in the GS downgrading after the operation compared with the control group (p < 0.05). In the overall cohort, multiple analyses showed that initial PSA level, GS at biopsy, clinical T stage, lymph node invasion, use of NHT, and surgical methods were significantly associated with positive surgical margin (p < 0.05) while NHT did not account for biochemical recurrence (p > 0.05).
NHT can lower the difficulty of surgery, reduce positive surgical margin rate, and help recovery in short-term urinary control in patients with high-risk prostate cancer after LRP. However, we do not have evidence on the benefit of NHT in high-risk PCa patients treated with RALP. For these patients, surgery can be performed as early as possible.