Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom

Translated title of the contribution: Propensity score comparison of the various radical surgical techniques for high-risk prostate cancer

J. Busch, Mark L Gonzalgo, N. Leva, M. Ferrari, F. Friedersdorff, S. Hinz, C. Kempkensteffen, K. Miller, A. Magheli

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence. Patients and Methods: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models. Results: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant). Conclusion: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.

Original languageGerman
Pages (from-to)45-51
Number of pages7
JournalAktuelle Urologie
Volume46
Issue number1
DOIs
StatePublished - 2015

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Propensity Score
Prostatic Neoplasms
Neoplasm Grading
Recurrence
Survival
Prostatectomy
Proportional Hazards Models
Survival Rate
Biopsy

Keywords

  • high risk
  • laparoscopy
  • oncologic outcome
  • propensity score matching
  • prostate cancer
  • prostatectomy
  • robotic surgery

ASJC Scopus subject areas

  • Urology

Cite this

Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom. / Busch, J.; Gonzalgo, Mark L; Leva, N.; Ferrari, M.; Friedersdorff, F.; Hinz, S.; Kempkensteffen, C.; Miller, K.; Magheli, A.

In: Aktuelle Urologie, Vol. 46, No. 1, 2015, p. 45-51.

Research output: Contribution to journalArticle

Busch, J, Gonzalgo, ML, Leva, N, Ferrari, M, Friedersdorff, F, Hinz, S, Kempkensteffen, C, Miller, K & Magheli, A 2015, 'Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom', Aktuelle Urologie, vol. 46, no. 1, pp. 45-51. https://doi.org/10.1055/s-0034-1395562
Busch, J. ; Gonzalgo, Mark L ; Leva, N. ; Ferrari, M. ; Friedersdorff, F. ; Hinz, S. ; Kempkensteffen, C. ; Miller, K. ; Magheli, A. / Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom. In: Aktuelle Urologie. 2015 ; Vol. 46, No. 1. pp. 45-51.
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abstract = "Introduction: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence. Patients and Methods: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models. Results: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7{\%} for RARP, in 8.2, 36.4, 55.5{\%} for LRP and in 0, 60.9 and 39.1{\%} for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0{\%} for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1{\%} (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100{\%} respectively (statistically not significant). Conclusion: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.",
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T1 - Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom

AU - Busch, J.

AU - Gonzalgo, Mark L

AU - Leva, N.

AU - Ferrari, M.

AU - Friedersdorff, F.

AU - Hinz, S.

AU - Kempkensteffen, C.

AU - Miller, K.

AU - Magheli, A.

PY - 2015

Y1 - 2015

N2 - Introduction: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence. Patients and Methods: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models. Results: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant). Conclusion: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.

AB - Introduction: The optimal surgical treatment of patients with a high risk prostate cancer (PCa) in terms of radical prostatectomy (RP) is still controversial: open retropubic RP (RRP), laparoscopic RP (LRP), or robot-assisted (RARP). We aimed to investigate the influence of the different surgical techniques on pathologic outcome and biochemical recurrence. Patients and Methods: A total of 805 patients with a high risk PCa (PSA >20 ng/mL, Gleason Score ≥8, or clinical stage ≥cT2c) were included. A comparison of 407 RRP patients with 398 minimally invasive cases (LRP+RARP) revealed significant confounders. Therefore all 110 RARP cases were propensity score (PS) matched 1:1 with LRP and RRP patients. PS included age, clinical stage, preoperative PSA, biopsy Gleason score, surgeon's experience and application of a nerve sparing technique. Comparison of overall survival (OS) and recurrence-free survival (RFS) was done with the log rank test. Predictors of RFS were analyzed by means of Cox regression models. Results: Within the post-matching cohort of 330 patients a pathologic Gleason score < 7, = 7 and > 7 was found in 1.8, 55.5 and 42.7% for RARP, in 8.2, 36.4, 55.5% for LRP and in 0, 60.9 and 39.1% for RRP (p=0.004 for RARP vs. LRP and p=0.398 for RARP vs. RRP). Differences in histopathologic stages were not statistically significant. The overall positive surgical margin rate (PSM) as well as PSM for ≥ pT3 were not different. PSM among patients with pT2 was found in 15.7, 14.0 and 20.0% for RARP, LRP and RRP (statistically not significant). The respective mean 3-year RFS rates were 41.4, 77.9, 54.1% (p<0.0001 for RARP vs. LRP and p=0.686 for RARP vs. RRP). The mean 3-year OS was calculated as 95.4, 98.1 and 100% respectively (statistically not significant). Conclusion: RARP for patients with a high risk PCa reveals similar pathologic and oncologic outcomes compared with LRP and RRP.

KW - high risk

KW - laparoscopy

KW - oncologic outcome

KW - propensity score matching

KW - prostate cancer

KW - prostatectomy

KW - robotic surgery

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