Risk Factors For Biochemical Recurrence After Robot-assisted Laparoscopic Radical Prostatectomy And The Influence Of Neoadjuvant Hormonal Therapy On Biochemical Recurrence

Purpose: To evaluate the biochemical recurrence(BCR)of patients after robot-assisted laparoscopic radical prostatectomy(RARP).Explore the risk factors of BCR and the effect of preoperative neoadjuvant hormonal therapy(NHT)on it to provide suggestions for using NHT before performing operations and improving the follow-up and management of patients with high BCR risk after RARP.Materials and methods: The clinical data of 244 patients who underwent RARP in the First Affiliated Hospital of China Medical University from April 2018 to January 2022 were retrospectively analyzed,including 164 patients who only underwent RARP surgery and 80 patients who underwent NHT before RARP surgery.The clinical data included:whether to receive NHT,age at the time of RARP operation,body mass index(BMI),serum prostate-specific antigen(PSA)level before receiving NHT or RARP treatment,postoperative pathological Gleason score,pathological stage,risk group,pelvic lymph node metastasis,positive surgical margin,surgical approach(transperitoneal or extraperitoneal approach),surgical period and whether BCR.BCR is defined as PSA≥0.2 ng/ml for two consecutive tests after the operation.Kaplan-Meier survival analysis was conducted to calculate the postoperative BCR rate and draw BCR-free survival(BCRFS)curves.The clinical data of patients were analyzed by univariate and multivariate COX regression analysis to explore the risk factors of BCR after RARP.The patients in the non-NHT group and the NHT group were selected by the 1:1 propensity score matching.After controlling other confounding baseline factors,the univariate and multivariate COX regression analysis was conducted to investigate the effect of NHT on the postoperative BCR.Results: Among 164 patients without NHT who only underwent RARP,the mean follow-up period is 19.5 months.35 incidences of BCR were observed finally,and the total BCR rate was 47%.The estimated BCR rates for this cohort in 1,2,and 3 years were 12.9%,22.9%,and 28.4%,respectively.The results of univariate COX regression analysis showed that preoperative PSA(P<0.05),Gleason score(P=0.01),high-risk groups classification(P=0.04),and pelvic lymph node metastasis(P=0.03)were significantly associated with BCR.Multivariate COX regression analysis showed that PSA >20 ng/ml(HR=5.90,95% CI 1.74-20.01,P<0.01)and Gleason score ≥8(HR=2.22,95% CI 1.13-4.36,P=0.02)were independent risk factors for BCR after RARP.110 patients were selected by 1:1 propensity score matching,including 55 NHT patients and55 non-NHT patients.There was no significant difference in baseline characteristics between the two groups.Univariate COX regression analysis in these 110 patients showed that NHT(P=0.03)and pelvic lymph node metastasis(P=0.04)were correlated with BCR.Multivariate COX regression analysis showed that NHT(HR=0.43,95% CI0.20-0.94,P=0.03)was an independent protective factor for BCR.Conclusions: This study investigated the BCR rate after RARP in a single center and indicated that PSA >20 ng/ml and Gleason score ≥8 were independent risk factors of BCR.NHT is an independent protective factor of BCR,and preoperative NHT can reduce the risk of BCR after RARP in some patients.The results of this study will provide suggestions for the use of NHT and improve the follow-up and management of patients with high BCR risk after RARP.