Comparison of oncologic outcomes following robot-assisted radical prostatectomy in high- and very high-risk prostate cancer based on the 2025 National Comprehensive Cancer Network risk stratification.
[INTRODUCTION] National Comprehensive Cancer Network (NCCN) risk stratification was updated in 2025.
- 95% CI 2.38-5.58
- 추적기간 48 months
APA
Ozawa Y, Saikali S, et al. (2026). Comparison of oncologic outcomes following robot-assisted radical prostatectomy in high- and very high-risk prostate cancer based on the 2025 National Comprehensive Cancer Network risk stratification.. Urologic oncology, 44(1), 71.e9-71.e18. https://doi.org/10.1016/j.urolonc.2025.09.015
MLA
Ozawa Y, et al.. "Comparison of oncologic outcomes following robot-assisted radical prostatectomy in high- and very high-risk prostate cancer based on the 2025 National Comprehensive Cancer Network risk stratification.." Urologic oncology, vol. 44, no. 1, 2026, pp. 71.e9-71.e18.
PMID
41111015
Abstract
[INTRODUCTION] National Comprehensive Cancer Network (NCCN) risk stratification was updated in 2025. We compared oncologic outcomes between high-risk (HR) and very high-risk (VHR) prostate cancer following robot-assisted radical prostatectomy (RARP).
[METHODS] Among 14,878 men who underwent RARP from 2008 to 2023, 2,871 and 100 met the 2025 NCCN HR and VHR criteria. Cumulative incidences of biochemical recurrence (BCR), cancer-specific mortality, and all-cause mortality were compared between two groups using Kaplan-Meier curves and log-rank tests. Prostate-specific antigen (PSA) persistence was also compared. Multivariable logistic and Cox regression models were used to adjust for potential confounders: age, race, ethnicity, comorbidity, neoadjuvant hormonal therapy, and surgery year. Further, we conducted multivariable analyses to identify VHR features (cT3-4, grade group 4-5, and PSA > 40 ng/ml) associated with PSA persistence and BCR.
[RESULTS] VHR patients were 4.25 and 3.37 times more likely to have pT4 and pN1 disease, respectively; 35% exhibited PSA persistence. After adjustment, VHR patients continued to exhibit higher risks of PSA persistence (odds ratio: 3.67, 95% CI: 2.38-5.58) and BCR (hazard ratio: 2.36, 95% CI: 1.65-3.38). Cancer-specific and all-cause mortality were comparable; however, the short follow-up (median 48 months, interquartile range: 24-72) limited mortality analyses. All VHR features were independent predictors of PSA persistence and BCR.
[CONCLUSIONS] The 2025 NCCN VHR stratification is associated with adverse pathology, PSA persistence, and BCR. Preoperative counseling-including discussion of the potential need for neoadjuvant, adjuvant, and salvage therapy-and meticulous patient selection are essential when considering RARP as an initial treatment for patients with HR, particularly VHR disease, within a multidisciplinary framework.
[METHODS] Among 14,878 men who underwent RARP from 2008 to 2023, 2,871 and 100 met the 2025 NCCN HR and VHR criteria. Cumulative incidences of biochemical recurrence (BCR), cancer-specific mortality, and all-cause mortality were compared between two groups using Kaplan-Meier curves and log-rank tests. Prostate-specific antigen (PSA) persistence was also compared. Multivariable logistic and Cox regression models were used to adjust for potential confounders: age, race, ethnicity, comorbidity, neoadjuvant hormonal therapy, and surgery year. Further, we conducted multivariable analyses to identify VHR features (cT3-4, grade group 4-5, and PSA > 40 ng/ml) associated with PSA persistence and BCR.
[RESULTS] VHR patients were 4.25 and 3.37 times more likely to have pT4 and pN1 disease, respectively; 35% exhibited PSA persistence. After adjustment, VHR patients continued to exhibit higher risks of PSA persistence (odds ratio: 3.67, 95% CI: 2.38-5.58) and BCR (hazard ratio: 2.36, 95% CI: 1.65-3.38). Cancer-specific and all-cause mortality were comparable; however, the short follow-up (median 48 months, interquartile range: 24-72) limited mortality analyses. All VHR features were independent predictors of PSA persistence and BCR.
[CONCLUSIONS] The 2025 NCCN VHR stratification is associated with adverse pathology, PSA persistence, and BCR. Preoperative counseling-including discussion of the potential need for neoadjuvant, adjuvant, and salvage therapy-and meticulous patient selection are essential when considering RARP as an initial treatment for patients with HR, particularly VHR disease, within a multidisciplinary framework.
MeSH Terms
Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Middle Aged; Aged; Risk Assessment; Treatment Outcome
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