Francesca Ambrosini, Felix Preisser, Derya Tilki, Hans Heinzer, Georg Salomon, Uwe Michl, Thomas Steuber, Tobias Maurer, Felix K H Chun, Lars Budäus, Randi M Pose, Carlo Terrone, Thorsten Schlomm, Pierre Tennstedt, Hartwig Huland, Markus Graefen, Alexander Haese
{"title":"使用神经血管结构邻近冰冻切片检查（NeuroSAFE）进行保留神经的根治性前列腺切除术：20 年后的结果。","authors":"Francesca Ambrosini, Felix Preisser, Derya Tilki, Hans Heinzer, Georg Salomon, Uwe Michl, Thomas Steuber, Tobias Maurer, Felix K H Chun, Lars Budäus, Randi M Pose, Carlo Terrone, Thorsten Schlomm, Pierre Tennstedt, Hartwig Huland, Markus Graefen, Alexander Haese","doi":"10.1038/s41391-024-00851-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the long-term oncological outcomes and functional results of the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during nerve-sparing (NS) radical prostatectomy (RP).</p><p><strong>Materials and methods: </strong>A 10-yr survival analysis on 11069 RPs performed with or without the NeuroSAFE, between January 2002 to June 2011 was carried out. In the NeuroSAFE cohort, the neurovascular structure-adjacent prostatic margins are removed and stained for cryo-sectioning during RP. In case of a PSM, partial or full removal of the neurovascular bundle was performed. The impact of NeuroSAFE on biochemical recurrence-free survival (BFS), salvage radiation therapy-free survival, metastasis-free survival, and prostate cancer-specific survival at 10 years was analyzed. 1-year (1-yr) erectile function (EF), 1-yr, and 2-yr continence rates were assessed in propensity score-based matched cohorts.</p><p><strong>Results: </strong>Median follow-up was 121 (IQR: 73, 156) months. No differences in BFS between NeuroSAFE and non-NeuroSAFE were recorded (10-yr BFS: NeuroSAFE vs non-Neurosafe, pT2: 81% vs 84%, p = 0.06; pT3a: 58% vs. 63%, p = 0.6; ≥pT3b: 22% vs. 27%, p = 0.99). No differences were found between the two groups in terms of sRFS (pT2: p = 0.1; pT3a: p = 0.4; ≥pT3b: p = 0.4) (Fig. 1B, Table 2), and MTS (pT2: p = 0.3; pT3a: p = 0.6; ≥pT3b: p = 0.9). The NeuroSAFE-navigated patients reported a better 1-yr EF than non-NeuroSAFE (68% vs. 58%, p = 0.02) and no differences in 1-yr and 2-yr continence rates (92.4% vs. 91.8%, and 93.4% vs. 93%, respectively). The main limitation is the retrospective study design.</p><p><strong>Conclusions: </strong>While the NeuroSAFE approach did not show significant improvements in long-term oncologic or continence outcomes, it did provide an opportunity for a higher proportion of patients to improve postoperative functional results, possibly through increased nerve-sparing procedures.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1000,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nerve-sparing radical prostatectomy using the neurovascular structure-adjacent frozen-section examination (NeuroSAFE): results after 20 years of experience.\",\"authors\":\"Francesca Ambrosini, Felix Preisser, Derya Tilki, Hans Heinzer, Georg Salomon, Uwe Michl, Thomas Steuber, Tobias Maurer, Felix K H Chun, Lars Budäus, Randi M Pose, Carlo Terrone, Thorsten Schlomm, Pierre Tennstedt, Hartwig Huland, Markus Graefen, Alexander Haese\",\"doi\":\"10.1038/s41391-024-00851-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To evaluate the long-term oncological outcomes and functional results of the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during nerve-sparing (NS) radical prostatectomy (RP).</p><p><strong>Materials and methods: </strong>A 10-yr survival analysis on 11069 RPs performed with or without the NeuroSAFE, between January 2002 to June 2011 was carried out. In the NeuroSAFE cohort, the neurovascular structure-adjacent prostatic margins are removed and stained for cryo-sectioning during RP. In case of a PSM, partial or full removal of the neurovascular bundle was performed. The impact of NeuroSAFE on biochemical recurrence-free survival (BFS), salvage radiation therapy-free survival, metastasis-free survival, and prostate cancer-specific survival at 10 years was analyzed. 1-year (1-yr) erectile function (EF), 1-yr, and 2-yr continence rates were assessed in propensity score-based matched cohorts.</p><p><strong>Results: </strong>Median follow-up was 121 (IQR: 73, 156) months. No differences in BFS between NeuroSAFE and non-NeuroSAFE were recorded (10-yr BFS: NeuroSAFE vs non-Neurosafe, pT2: 81% vs 84%, p = 0.06; pT3a: 58% vs. 63%, p = 0.6; ≥pT3b: 22% vs. 27%, p = 0.99). No differences were found between the two groups in terms of sRFS (pT2: p = 0.1; pT3a: p = 0.4; ≥pT3b: p = 0.4) (Fig. 1B, Table 2), and MTS (pT2: p = 0.3; pT3a: p = 0.6; ≥pT3b: p = 0.9). The NeuroSAFE-navigated patients reported a better 1-yr EF than non-NeuroSAFE (68% vs. 58%, p = 0.02) and no differences in 1-yr and 2-yr continence rates (92.4% vs. 91.8%, and 93.4% vs. 93%, respectively). The main limitation is the retrospective study design.</p><p><strong>Conclusions: </strong>While the NeuroSAFE approach did not show significant improvements in long-term oncologic or continence outcomes, it did provide an opportunity for a higher proportion of patients to improve postoperative functional results, possibly through increased nerve-sparing procedures.</p>\",\"PeriodicalId\":20727,\"journal\":{\"name\":\"Prostate Cancer and Prostatic Diseases\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2024-06-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Prostate Cancer and Prostatic Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1038/s41391-024-00851-x\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Prostate Cancer and Prostatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41391-024-00851-x","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的评估神经保留（NS）根治性前列腺切除术（RP）中神经血管结构邻近冰冻切片检查（NeuroSAFE）的长期肿瘤治疗效果和功能结果：对2002年1月至2011年6月期间进行的11069例前列腺癌根治术（RP）进行了10年生存分析。在NeuroSAFE队列中，在前列腺电切术中切除神经血管结构相邻的前列腺边缘并进行冷冻切片染色。如果出现 PSM，则会部分或全部切除神经血管束。分析了 NeuroSAFE 对 10 年无生化复发生存率（BFS）、无挽救性放疗生存率、无转移生存率和前列腺癌特异性生存率的影响。在基于倾向评分的匹配队列中评估了1年（1-yr）勃起功能（EF）、1年和2年失禁率：中位随访时间为121个月（IQR：73，156）。NeuroSAFE与非NeuroSAFE的BFS无差异（10年BFS：NeuroSAFE vs 非Neurosafe，pT2：81% vs 84%，p = 0.06；pT3a：58% vs 63%，p = 0.6；≥pT3b：22% vs 27%，p = 0.99）。两组的 sRFS（pT2：p = 0.1；pT3a：p = 0.4；≥pT3b：p = 0.4）和 MTS（pT2：p = 0.3；pT3a：p = 0.6；≥pT3b：p = 0.9）无差异（图 1B，表 2）。NeuroSAFE导航患者的1年EF值优于非NeuroSAFE患者（68% vs. 58%，p = 0.02），1年和2年尿失禁率也无差异（分别为92.4% vs. 91.8%和93.4% vs. 93%）。主要局限是研究设计具有回顾性：结论：虽然NeuroSAFE方法在长期肿瘤学或尿失禁预后方面没有显示出明显改善，但它确实为更高比例的患者提供了改善术后功能结果的机会，这可能是通过增加神经保留手术实现的。
Nerve-sparing radical prostatectomy using the neurovascular structure-adjacent frozen-section examination (NeuroSAFE): results after 20 years of experience.
Objectives: To evaluate the long-term oncological outcomes and functional results of the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during nerve-sparing (NS) radical prostatectomy (RP).
Materials and methods: A 10-yr survival analysis on 11069 RPs performed with or without the NeuroSAFE, between January 2002 to June 2011 was carried out. In the NeuroSAFE cohort, the neurovascular structure-adjacent prostatic margins are removed and stained for cryo-sectioning during RP. In case of a PSM, partial or full removal of the neurovascular bundle was performed. The impact of NeuroSAFE on biochemical recurrence-free survival (BFS), salvage radiation therapy-free survival, metastasis-free survival, and prostate cancer-specific survival at 10 years was analyzed. 1-year (1-yr) erectile function (EF), 1-yr, and 2-yr continence rates were assessed in propensity score-based matched cohorts.
Results: Median follow-up was 121 (IQR: 73, 156) months. No differences in BFS between NeuroSAFE and non-NeuroSAFE were recorded (10-yr BFS: NeuroSAFE vs non-Neurosafe, pT2: 81% vs 84%, p = 0.06; pT3a: 58% vs. 63%, p = 0.6; ≥pT3b: 22% vs. 27%, p = 0.99). No differences were found between the two groups in terms of sRFS (pT2: p = 0.1; pT3a: p = 0.4; ≥pT3b: p = 0.4) (Fig. 1B, Table 2), and MTS (pT2: p = 0.3; pT3a: p = 0.6; ≥pT3b: p = 0.9). The NeuroSAFE-navigated patients reported a better 1-yr EF than non-NeuroSAFE (68% vs. 58%, p = 0.02) and no differences in 1-yr and 2-yr continence rates (92.4% vs. 91.8%, and 93.4% vs. 93%, respectively). The main limitation is the retrospective study design.
Conclusions: While the NeuroSAFE approach did not show significant improvements in long-term oncologic or continence outcomes, it did provide an opportunity for a higher proportion of patients to improve postoperative functional results, possibly through increased nerve-sparing procedures.
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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