文章：

基于外周带无前列腺影像报告与数据系统评分≥3或活检格里森模式≥4的神经保留机器人辅助根治性前列腺切除术

Nerve-Sparing Robotic-Assisted Radical Prostatectomy Based on the Absence of Prostate Imaging-Reporting and Data System ≥3 or Biopsy Gleason Pattern ≥4 in the Peripheral Zone

原文发布日期：12 March 2025

DOI: 10.3390/cancers17060962

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: The objective of this study was to evaluate the oncological outcomes and safety of nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) when applied without Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions or Gleason pattern ≥4 on biopsy in the peripheral zone (PZ).Methods: We retrospectively analyzed 208 patients who underwent RARP between August 2017 and December 2022, excluding those who had received preoperative hormonal therapy. After NS status stratification and patient characteristic adjustment using propensity score matching (PSM), positive resection margin (RM) rates and prostate-specific antigen (PSA) recurrence-free survival were compared. Urinary and sexual quality of life (QOL) were assessed using the Expanded Prostate Cancer Index Composite, along with predictive factors associated with positive RM and RM locations in the NS group.Results: NS was performed in 68.6% (n= 129) patients. After PSM, there were no significant differences in RM positivity (p= 0.811) or PSA recurrence-free survival (Log-rankp= 0.79), regardless of NS status. There was no difference in sexual function between groups, but urinary QOL was significantly better in the NS group from the third month onward. In the NS group, RM positivity was 27.9% (n = 36), and diagnostic PSA (odds ratio [OR], 1.110,p= 0.038) and clinical T stage (OR, 1.400,p= 0.038) were predictive factors. The RM positivity rate on the NS side was 10.8%.Conclusions: NS, based on the absence of PI-RADS ≥3 lesions or Gleason pattern ≥4 in PZ, did not increase RM positivity rate and increased early urinary QOL.

摘要翻译： 

背景/目的：本研究旨在评估，对于前列腺外周带（PZ）无前列腺影像报告和数据系统（PI-RADS）评分≥3的病灶或活检格里森分级模式<4的患者，实施保留神经（NS）的机器人辅助根治性前列腺切除术（RARP）的肿瘤学结果和安全性。 方法：我们回顾性分析了2017年8月至2022年12月期间接受RARP的208例患者，排除了术前接受过激素治疗的患者。在使用倾向评分匹配（PSM）进行NS状态分层和患者特征调整后，比较了阳性切缘（RM）率和前列腺特异性抗原（PSA）无复发生存率。使用扩展前列腺癌综合指数评估了泌尿和性生活质量（QOL），并分析了NS组中与阳性RM及RM位置相关的预测因素。 结果：68.6%（n=129）的患者接受了NS手术。PSM后，无论NS状态如何，RM阳性率（p=0.811）和PSA无复发生存率（Log-rank p=0.79）均无显著差异。两组间性功能无差异，但从术后第三个月起，NS组的泌尿QOL显著更优。在NS组中，RM阳性率为27.9%（n=36），诊断时PSA水平（比值比[OR]，1.110，p=0.038）和临床T分期（OR，1.400，p=0.038）是预测因素。NS侧的RM阳性率为10.8%。 结论：基于PZ无PI-RADS ≥3病灶或格里森模式<4而实施的NS手术，并未增加RM阳性率，并提高了早期泌尿QOL。

原文链接：

Nerve-Sparing Robotic-Assisted Radical Prostatectomy Based on the Absence of Prostate Imaging-Reporting and Data System ≥3 or Biopsy Gleason Pattern ≥4 in the Peripheral Zone