机器人和腹腔镜根治性膀胱切除术治疗膀胱癌：长期肿瘤学结果。
Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes.
机构信息
Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
出版信息
Eur Urol. 2014 Jan;65(1):193-200. doi: 10.1016/j.eururo.2013.08.021. Epub 2013 Aug 20.
BACKGROUND
Extended oncologic outcomes after minimally invasive cystectomy have not been previously reported.
OBJECTIVE
To report outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) for bladder cancer (BCa) at up to 12-yr follow-up.
DESIGN, SETTING, AND PARTICIPANTS: All 121 patients undergoing RARC or LRC for BCa between December 1999 and September 2008 at a tertiary referral center were retrospectively evaluated from a prospectively maintained database.
INTERVENTION
RARC or LRC.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Primary end points were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) calculated using Kaplan-Meier curves. Secondary end points were survival analysis by number of lymph nodes (LNs) and type of procedure. Surgical outcomes, including complications, were analyzed.
RESULTS AND LIMITATIONS
Most tumors were muscle invasive (≥ pT2; n=81; 67%) urothelial carcinomas (n=102; 84%). Extended LN dissection was performed in 98 patients (81%), with a median of 14 nodes removed (interquartile range [IQR]: 8-18). Twenty-four patients (20%) had node-positive disease (N1: 10 [8%]; N2: 14 [12%]). Eight patients (6.6%) had positive soft tissue margins. Median follow-up was 5.5 yr (mean: 5.9; IQR: 4.2-8.2; range: 0.13-12.1). At last follow-up, 58 patients (48%) had no evidence of disease, 3 (2%) were alive with recurrence, 59 (49%) had died, and status was unknown in 1. Twenty-eight patients (23%) died from cancer-specific causes, 20 (17%) from unrelated causes, and 11 (9%) from unknown causes. The 10-yr actuarial OS, CSS, and RFS rates were 35%, 63%, and 54%, respectively. At last follow-up, OS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 67%, 73%, 53%, 50%, and 16% versus 0%, respectively (p=0.02). At last follow-up, CSS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 100%, 91%, 74%, 77%, and 56% versus 0%, respectively (p=0.03).
CONCLUSIONS
The longest oncologic outcomes following RARC and LRC for BCa reported demonstrates results similar to those reported for open RC. Continued analysis and direct randomized comparison between techniques is necessary.
背景
微创膀胱切除术的扩展肿瘤学结果以前尚未报道过。
目的
报告在三级转诊中心接受机器人辅助根治性膀胱切除术（RARC）和腹腔镜根治性膀胱切除术（LRC）治疗膀胱癌（BCa）的患者，随访时间最长可达 12 年。
设计、设置和参与者：从一个前瞻性维护的数据库中回顾性评估了 1999 年 12 月至 2008 年 9 月期间在三级转诊中心接受 RARC 或 LRC 治疗的 121 例膀胱癌患者。
干预措施
RARC 或 LRC。
主要结局测量和统计学分析
主要终点是使用 Kaplan-Meier 曲线计算总生存（OS）、癌症特异性生存（CSS）和无复发生存（RFS）。次要终点是通过淋巴结（LNs）数量和手术类型进行生存分析。分析了手术结果，包括并发症。
结果和局限性
大多数肿瘤为肌层浸润性（≥pT2；n=81；67%）尿路上皮癌（n=102；84%）。98 例患者（81%）进行了广泛的淋巴结清扫术，中位数切除 14 个淋巴结（四分位距[IQR]：8-18）。24 例（20%）患者有淋巴结阳性疾病（N1：10[8%]；N2：14[12%]）。8 例（6.6%）患者有软组织切缘阳性。中位随访时间为 5.5 年（平均：5.9；IQR：4.2-8.2；范围：0.13-12.1）。在最后一次随访时，58 例患者（48%）无疾病证据，3 例（2%）患者复发后存活，59 例（49%）患者死亡，1 例患者状态不明。28 例（23%）患者死于癌症特异性原因，20 例（17%）患者死于非相关原因，11 例（9%）患者死于未知原因。10 年的总生存率、CSS 和 RFS 率分别为 35%、63%和 54%。在最后一次随访时，pT0、pTis/a、pT1、pT2 和 pT3 与 pT4 的 OS 分别为 67%、73%、53%、50%和 16%与 0%（p=0.02）。在最后一次随访时，pT0、pTis/a、pT1、pT2 和 pT3 与 pT4 的 CSS 分别为 100%、91%、74%、77%和 56%与 0%（p=0.03）。
结论
报道的 RARC 和 LRC 治疗 BCa 的最长肿瘤学结果与开放 RC 报道的结果相似。需要对技术进行持续分析和直接随机比较。
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