The application of mixed reality navigation system in robot-assisted radical prostatectomy for high-risk prostate cancer: a propensity score‑matched cohort study.
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Abstract
Background: This study aims to evaluate the efficacy and advantages of MR navigation system in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer (PCa).
Methods: We retrospectively studied 147 patients with high-risk PCa based on D'Amico risk criteria from July 2021 to November 2023. All patients chose MR-assisted RARP (MR-RARP) or standard RARP (S-RARP) after receiving comprehensive counseling on the benefits and risks of both procedures. After propensity score-matching, 57 patients were included in each group. Perioperative, functional and oncological outcomes were compared. Logistic and Cox regression models were used to identify predictors of positive surgical margin (PSM), biochemical recurrence (BCR), continence and potency recovery.
Results: The MR-RARP group had higher nerve-sparing (NS) rates (78.9% vs 54.4%, P = 0.021) and lower PSM rates (10.5% vs 26.3%, P = 0.030). Continence recovery rates were higher in the MR-RARP group at catheter removal (40.4% vs 22.8%, P = 0.044), 1 month (61.4% vs 38.6%, P = 0.015) and 3 months (73.7% vs 47.4%, P = 0.004), with no significant differences at 6 months (82.5% vs 73.7%, P = 0.258) and 12 months (93.0% vs 87.7%, P = 0.341). Furthermore, the MR-RARP group demonstrated higher potency rates at 1 month (42.1% vs 21.1%, P = 0.016) and 3 months (57.9% vs 36.8%, P = 0.024), whereas outcomes were comparable at 6 months (66.7% vs 56.1%, P = 0.248) and 12 months (77.2% vs 66.7%, P = 0.211). With a median follow-up of 28 months, BCR-free survival showed no significant differences (P = 0.295). Multivariate analyses confirmed MR navigation as an independent predictor of PSM, continence, and potency recovery (all P < 0.05). Statistical power analysis indicated a power of 0.847.
Conclusions: Real-time intraoperative MR navigation enhances surgical precision, facilitates NS techniques, and optimizes early continence and potency recovery without compromising oncological safety.
背景：本研究旨在评估MR导航系统在机器人辅助根治性前列腺切除术（RARP）治疗高危前列腺癌（PCa）中的疗效和优势。方法：我们回顾性研究了从2021年7月至2023年11月147例基于D'Amico风险标准的高危PCa患者。所有患者在接受了两种方法的利弊综合咨询后，均选择了MR-RARP （MR-RARP）或S-RARP （S-RARP）。倾向评分匹配后，每组57例。比较围手术期、功能和肿瘤预后。采用Logistic和Cox回归模型确定手术切缘阳性（PSM）、生化复发（BCR）、尿失禁和药力恢复的预测因子。结果：MR-RARP组神经保留率较高（78.9% vs 54.4%, P = 0.021）， PSM率较低（10.5% vs 26.3%, P = 0.030）。MR-RARP组在拔管时尿失禁恢复率较高（40.4% vs 22.8%, P = 0.044）， 1个月（61.4% vs 38.6%, P = 0.015）和3个月（73.7% vs 47.4%, P = 0.004）， 6个月（82.5% vs 73.7%, P = 0.258）和12个月（93.0% vs 87.7%, P = 0.341）无显著差异。此外，MR-RARP组在1个月（42.1%对21.1%,P = 0.016）和3个月（57.9%对36.8%,P = 0.024）时表现出更高的效力率，而6个月（66.7%对56.1%,P = 0.248）和12个月（77.2%对66.7%,P = 0.211）时的结果具有可比性。中位随访28个月，无bcr生存率无显著差异（P = 0.295）。多变量分析证实MR导航是PSM、尿失禁和药力恢复的独立预测因子（均为P）。结论：术中实时MR导航提高了手术精度，促进了NS技术，并在不影响肿瘤安全性的情况下优化了早期尿失禁和药力恢复。
期刊介绍：
Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management.
Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis.
Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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