title: Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.|Department of Urology I, Xinxiang Central Hospital, Xinxiang, Henan, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Baojun
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ai
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Xiangjun
authors.initials: X
authors.lastname: Lv
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Hongzhao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, No. 28, Fuxing Road, Beijing, 100853, China. xuzhang010pla@126.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D065287:Robotic Surgical Procedures; D015996:Survival Rate; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biochemical recurrence-free survival; Cancer-specific survival; Long term; Meta-analysis; Prostate cancer; Robot-assisted radical prostatectomy