Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis

Robot-assisted radical prostatectomy (RARP) provides significant advantages in short-term oncological outcomes for prostate cancer patients. However, data regarding the long-term cancer control outcomes of RARP are limited and inconsistent. This study aimed to evaluate these long-term outcomes.

Medline, Scopus, and other databases were searched for studies published from January 2010 to July 2016. Case series and prospective cohort studies on the long-term cancer control outcomes of patients who underwent RARP were subjected to meta-analyses by using the R statistical software. The rates of 5- and 10-year biochemical recurrence-free survival (BCRFS) and cancer-specific survival (CSS) were extracted from the included studies to assess these outcomes.

Twenty studies involving RARP with more than 5 years of follow-up were included. The pooled proportions of the 5-year BCRFS and CSS from 20 and 4 studies on RARP were 80% [95% confidence interval (CI) 0.77-0.82] and 97% (95% CI 0.96-0.98), respectively. The 10-year BCRFS rate from 5 studies was 79% (95% CI 0.72-0.86). Compared with the rate observed in open radical prostatectomy (ORP), the pooled 5-year BCRFS rate in the RARP group from 5 studies was significantly increased (P < 0.001, odds ratio 1.10, 95% CI 1.03-1.16). Their survival hazard ratios did not significantly differ (log rank P > 0.05). The effect size of the 5-year BCRFS was greater in the samples from the USA than in the samples from other regions (Z = - 10.424, P < 0.001). Publication date and clinical baselines, including preoperative PSA, Gleason scores, pathological stage, margin positive rate, lymph-node positive rate, and adjuvant therapy, also influenced the effect size of BCRFS (P < 0.001).

The meta-analysis of long-term cancer control outcomes demonstrated that RARP yielded satisfactory long-term BRFS and CSS, although the former was influenced by clinical baselines and unbalanced operative technological advantages in different study regions and years. The long-term BCRFS rates of RARP were higher than those of ORP, but the advantages of these survivals from these procedures were similar.

International urology and nephrology. 2017 Feb 25 [Epub ahead of print]

Lei Wang, Baojun Wang, Qing Ai, Yu Zhang, Xiangjun Lv, Hongzhao Li, Xin Ma, Xu Zhang

Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China., Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China. .