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

Research output: Contribution to journalArticle

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

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

Fingerprint

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

Keywords

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

ASJC Scopus subject areas

  • Urology

Cite this

Busch, J., Gonzalgo, M., Leva, N., Ferrari, M., Friedersdorff, F., Hinz, S., ... Magheli, A. (2015). Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom. Aktuelle Urologie, 46(1), 45-51. https://doi.org/10.1055/s-0034-1395562

Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom. / Busch, J.; Gonzalgo, M.; 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, M, 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, M. ; 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.
@article{e006eab9b45a41eb9ce88acb0f5ea65b,
title = "Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom",
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",
keywords = "high risk, laparoscopy, oncologic outcome, propensity score matching, prostate cancer, prostatectomy, robotic surgery",
author = "J. Busch and M. Gonzalgo and N. Leva and M. Ferrari and F. Friedersdorff and S. Hinz and C. Kempkensteffen and K. Miller and A. Magheli",
year = "2015",
doi = "10.1055/s-0034-1395562",
language = "German",
volume = "46",
pages = "45--51",
journal = "Aktuelle Urologie",
issn = "0001-7868",
publisher = "Georg Thieme Verlag",
number = "1",

}

TY - JOUR

T1 - Propensity Score Vergleich der verschiedenen radikalen Operationstechniken beim high risk Prostatakarzinom

AU - Busch, J.

AU - Gonzalgo, M.

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

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

KW - high risk

KW - laparoscopy

KW - oncologic outcome

KW - propensity score matching

KW - prostate cancer

KW - prostatectomy

KW - robotic surgery

UR - http://www.scopus.com/inward/record.url?scp=84923372659&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923372659&partnerID=8YFLogxK

U2 - 10.1055/s-0034-1395562

DO - 10.1055/s-0034-1395562

M3 - Article

C2 - 25526221

AN - SCOPUS:84923372659

VL - 46

SP - 45

EP - 51

JO - Aktuelle Urologie

JF - Aktuelle Urologie

SN - 0001-7868

IS - 1

ER -