Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England.
Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England.
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DOI：
10.1038/bjc.2017.454
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发表时间：
2018-02-20
影响因子：
8.8
通讯作者：
van der Meulen J
中科院分区：
文献类型：
--
作者：
Nossiter J;Sujenthiran A;Charman SC;Cathcart PJ;Aggarwal A;Payne H;Clarke NW;van der Meulen J
机器人辅助前列腺癌根治术(RARP)已被迅速采用，但尚未有确凿证据将其功能结果与腹腔镜前列腺癌根治术(LRP)或开放耻骨后前列腺癌根治术(ORP)进行比较。这项研究比较了RARP、LRP或ORP后患者报告的功能结果。所有在2014年4月至10月期间在英国接受前列腺癌根治术的男性都是从国家前列腺癌审计中确定的，并在确诊后18个月邮寄了一份调查问卷。患者报告的性、排尿、肠道和激素功能(EPIC-26领域评分)和一般健康相关生活质量(HRQL；EQ-5D-5L评分)的组间差异，经患者和肿瘤特征调整后，使用线性回归进行评估。总共有2219名男性(77.0%)有反应；1310名(59.0%)有RARP，487名(21.9%)有LRP，422名(19.0%)有ORP。与调整后的EPIC-26性功能评分(3.5分差值；95%可信区间：1.1-5.9，P=0.004)或较低分值(4分差值；95%可信区间：1.5-6.5分，P=0.002)相比，调整后的EPIC-26性功能评分略高，但均未达到最小临床重要性差值(10-12分)。在其他EPIC-26领域得分或HRQL方面没有显著差异。在英国NHS中迅速采用RARP不太可能在患者的功能结果方面产生实质性的改善。
Robot-assisted radical prostatectomy (RARP) has been rapidly adopted without robust evidence comparing its functional outcomes against laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (ORP) approaches. This study compared patient-reported functional outcomes following RARP, LRP or ORP. All men diagnosed with prostate cancer in England during April – October 2014 who underwent radical prostatectomy were identified from the National Prostate Cancer Audit and mailed a questionnaire 18 months after diagnosis. Group differences in patient-reported sexual, urinary, bowel and hormonal function (EPIC-26 domain scores) and generic health-related quality of life (HRQoL; EQ-5D-5L scores), with adjustment for patient and tumour characteristics, were estimated using linear regression. In all, 2219 men (77.0%) responded; 1310 (59.0%) had RARP, 487 (21.9%) LRP and 422 (19.0%) ORP. RARP was associated with slightly higher adjusted mean EPIC-26 sexual function scores compared with LRP (3·5 point difference; 95% CI: 1.1–5.9, P=0.004) or ORP (4.0 point difference; 95% CI: 1.5–6.5, P=0.002), which did not meet the threshold for a minimal clinically important difference (10–12 points). There were no significant differences in other EPIC-26 domain scores or HRQoL. It is unlikely that the rapid adoption of RARP in the English NHS has produced substantial improvements in functional outcomes for patients.
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DOI：
10.1016/s1470-2045(17)30572-7
发表时间：
2017-11
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Aggarwal A;Lewis D;Mason M;Purushotham A;Sullivan R;van der Meulen J
通讯作者：
van der Meulen J
影响因子：
45.3
作者：
Barry, Michael J.;Gallagher, Patricia M.;Fowler, Floyd J., Jr.
通讯作者：
Fowler, Floyd J., Jr.
影响因子：
23.4
作者：
Haglind, Eva;Carlsson, Stefan;Steineck, Gunnar
通讯作者：
Steineck, Gunnar
影响因子：
6.6
作者：
O'Neil, Brock;Koyama, Tatsuki;Penson, David F.
通讯作者：
Penson, David F.
影响因子：
3.6
作者：
Hutchings, Andrew;Neuburger, Jenny;van der Meulen, Jan
通讯作者：
van der Meulen, Jan