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

Abstract

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Biochemical recurrence-free survival; Cancer-specific survival; Long term; Meta-analysis; Prostate cancer; Robot-assisted radical prostatectomy.