对于开放式前列腺根治术，长期的肿瘤学疗效证据已经有了，但用于机器人辅助前列腺根治术（RARP）的证据仍然很少。为了验证RARP后的长期生存率，并根据现代前列腺癌（PCa）风险分层工具提供分层结果，我们进行了对欧洲泌尿学协会（EAU）机器人泌尿学科学工作组国际多中心数据库的回顾性分析。研究对象是在欧洲和美国的七个前卫机器人泌尿学计划中进行了RARP的患者，时间跨度为2002年至2012年。主要结局指标是PCa特异性死亡率和全因死亡率。我们采用竞争风险方法估计了癌症特异性生存（CSS）的概率，并采用Kaplan-Meier方法估计了总体生存（OS）的概率。纳入了在2002年至2012年间接受RARP的9876名患者。在随访期间，发生了1071例死亡，其中159例是由于PCa。随访15年时，CSS和OS分别为97.6%（97.2%，98.0%）和85.5%（84.6%，86.4%）。根据诊断时的EAU风险组和pT分期进行分层分析，结果显示了良好的生存率，低风险（n = 4601, 46.6%），中风险（n = 4056, 41.1%）和高风险（n = 1219, 12.3%）患者在随访15年时的CSS率分别为99%，98%和90%。值得注意的是，pT3a疾病患者的生存结果与pT2疾病患者相似，而pT3b PCa患者的CSS较差（98.9% vs 97.4% vs 86.5%）。多变量分析确定了年龄、前列腺特异性抗原、活检格里森分级组、临床T分期和治疗年份是恶性肿瘤结局较差的独立预测因子。我们的多中心研究通过长期随访证实了RARP对局限性PCa的良好生存结局。低风险和中风险患者面临比PCa更高的死亡风险。相反，高风险患者患PCa相关死亡的风险显著增加。在本研究中，我们报告了进行机器人辅助前列腺根治术的前列腺癌（PCa）患者在10年至20年前的结果，并发现低风险和中风险PCa患者死于PCa的概率非常低。版权所有© 2023。Elsevier B.V.出版。

Evidence on long-term oncological efficacy is available only for open radical prostatectomy but remains scarce for robot-assisted radical prostatectomy (RARP).To validate the long-term survival rates after RARP and provide stratified outcomes based on contemporary prostate cancer (PCa) risk-stratification tools.A retrospective analysis of the European Association of Urology (EAU) Robotic Urology Section Scientific Working Group international multicenter database for RARP was performed. Patients who underwent RARP at seven pioneer robotic urology programs in Europe and the USA between 2002 and 2012 were included.The primary outcomes were PCa-specific mortality and all-cause mortality. The probability of cancer-specific survival (CSS) was estimated with the competing risks method, and the probability of overall survival (OS) was estimated with the Kaplan-Meier method.A total of 9876 patients who underwent RARP between 2002 and 2012 were included. Within follow-up, 1071 deaths occurred and 159 were due to PCa. At 15 yr of follow-up, CSS and OS were 97.6% (97.2%, 98.0%) and 85.5% (84.6%, 86.4%), respectively. Stratified analyses based on EAU risk groups at diagnosis and pT stage showed favorable survival rates, with low-risk (n = 4601, 46.6%), intermediate-risk (n = 4056, 41.1%), and high-risk (n = 1219, 12.3%) patients demonstrating CSS rates of 99%, 98%, and 90% at 15 yr, respectively. Notably, patients with pT3a disease had similar survival outcomes to those with pT2 disease, with worse CSS in patients with pT3b PCa (98.9% vs 97.4% vs 86.5%). Multivariable analyses identified age, prostate-specific antigen, biopsy Gleason grade group, clinical T stage, and treatment year as independent predictors of worse oncological outcomes.Our multicenter study with long-term follow-up confirms favorable survival outcomes after RARP for localized PCa. Patients with low- and intermediate-risk disease face a higher risk of mortality from causes other than PCa. On the contrary, high-risk patients have a significantly higher risk of PCa-specific mortality.In the present study, we reported the outcomes of patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy between 10 and 20 yr ago, and we found a very low probability of dying from PCa in patients with low- and intermediate-risk PCa.Copyright © 2023. Published by Elsevier B.V.