Comparative Effectiveness of Robot-assisted Versus Open Radical Prostatectomy Cancer Control
Menée à partir des données des registres des cancers et de la base Medicare portant sur 13 434 patients atteints d'un cancer de la prostate traité entre 2004 et 2009, cette étude rétrospective compare, du point de vue de la qualité des marges de résection, du contrôle de la maladie et de l'utilisation additionnelle d'une radiothérapie ou d'un traitement anti-androgénique, l'efficacité d'une prostatectomie radicale assistée par robot et d'une prostatectomie radicale par voie ouverte
Background : Robot-assisted radical prostatectomy (RARP) remains controversial, and no improvement in cancer control outcomes has been demonstrated over open radical prostatectomy (ORP). Objective : To examine population-based, comparative effectiveness of RARP versus ORP surgical margin status and use of additional cancer therapy. Design, setting, and participants : This was a retrospective observational study of 5556 RARP and 7878 ORP cases from 2004 to 2009 from Surveillance Epidemiology and End Results–Medicare linked data. Intervention : RARP versus ORP. Outcome measurements and statistical analysis : Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of RP surgical margin status and use of additional cancer therapy (radiation therapy [RT] or androgen deprivation therapy [ADT]) by surgical approach. Results and limitations : In the propensity-adjusted analysis, RARP was associated with fewer positive surgical margins (13.6% vs 18.3%; odds ratio [OR]: 0.70; 95% confidence interval [CI], 0.66–0.75), largely because of fewer RARP positive margins for intermediate-risk (15.0% vs 21.0%; OR: 0.66; 95% CI, 0.59–0.75) and high-risk (15.1% vs 20.6%; OR: 0.70; 95% CI, 0.63–0.77) disease. In addition, RARP was associated with less use of additional cancer therapy within 6 mo (4.5% vs 6.2%; OR: 0.75; 95% CI, 0.69–0.81), 12 mo (OR: 0.73; 95% CI, 0.62–0.86), and 24 mo (OR: 0.67; 95% CI, 0.57–0.78) of surgery. Limitations include the retrospective nature of the study and the absence of prostate-specific antigen levels to determine biochemical recurrence. Conclusions : RARP is associated with improved surgical margin status relative to ORP for intermediate- and high-risk disease and less use of postprostatectomy ADT and RT. This has important implications for quality of life, health care delivery, and costs. Patient summary : Robot-assisted radical prostatectomy (RP) versus open RP is associated with fewer positive margins and better early cancer control because of less use of additional androgen deprivation and radiation therapy within 2 yr of surgery. Take Home Message : Although robot-assisted radical prostatectomy (RARP) is more costly than open radical prostatectomy, our population-based study demonstrates that RARP is associated with fewer positive surgical margins and less use of additional cancer therapy within 2 yr postoperatively.