機械手臂根除性攝護腺切除術術後八年腫瘤控制的結果
歐宴泉、洪晟鈞、楊晨洸、程千里
臺中榮民總醫院 外科部泌尿科，*研究部
Oncologic outcomes at 8 years following robotic assisted radical prostatectomy
Yen-chuan Ou*, Sheng-chun Hung, Chun-Kuang Yang, Chen-Li Cheng
Division of Urology, Department of Surgery, *Department of Medical Research,
Taichung Veterans General Hospital
Objectives: To evaluate cancer control in men who underwent robotic assisted radical prostatectomy (RARP) at least 8 yr ago. From. Dec 2005 to Dec. 2008, we followed 111 consecutive men with localized prostate cancer who underwent RARP by a single surgeon.
Materials and Methods: The Mean age at RARP was 65.08 years. Mean PSA level at diagnosis : 18.57 ng/mL.Clinical stage was T1: 43.2%(48/111), T2 :50.5%(56/111) and T3: 6.3%(7/111). Biopsy Gleason score 5/6/7/8/9/10 was 5(4.5%)/51(45.9%)/32(28.8%)/11(9.9%)/10(9.0%)/2(1.8%).
The mean follow up 103.5 mo.We calculated biochemical recurrence -free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Acturial overall survival (OS) was calculated. Actuarial rates were estimated via Kaplan-Meier. Salvage therapy was reported. Three patients died of prostate cancer with metastasis and two patients died of other causes (lymphoma at 80 months and pneumonia with sepsis at 88 months).
Results: The Pathology stage was T2N0 :39.6%(44/111), T3N0: 50.5%(56/111), N1:9.9%(11/111) (T2N1:1, T3aN1:2, T3bN1:6, T4N1:2). Pathology Gleason score 5/6/7/8/9/10 was 3(2.7%)/ 26(23.4%)/57(51.3%)/3(2.7%)/20(18%)/2(1.8%). Upgraded noted in 41(36.93%), downgraded noted in 19(17.1%) and the same Gleason score in 51 (45.9%). There were 41 patients with BCR. The patients of BCR was received salvage irradiation in 10 patients and hormonal therapy at 31 patients. Actuarial BCRFS at 8 yr were 63.1%(70/111).Actuarial MFS at 8 yr were 95.4%(106/111).Actuarial CSS at 8 yr were 97.3%(108/111). Actuarial OS at 8 yr were 95.4.% (106/111).
- Actuarial BCRFS at 1yr, 3yr, 5 yr and 8 yr were 92.8%, 75.7%, 69.4% and 63.1%.
Conclusions: Robot-assisted radical prostatectomy confers effective 8-yr cancer control for men with localized disease. Persistent disease signals the risk of progression likely requiring early salvage treatment; lower postoperative risk warrants protracted surveillance beyond 5 yr from surgery, and those with higher risk may require follow-up beyond 10 yr.