1 Department of Urologic Oncology, City of Hope Comprehensive Cancer Center , Duarte, California.
J Endourol. 2014 Aug;28(8):939-45. doi: 10.1089/end.2014.0073. Epub 2014 Apr 16.
To evaluate intermediate-term oncologic outcomes in a large series of patients who were treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma of the bladder (UCB).
Between 2004 and 2010, 162 patients underwent RARC at City of Hope Cancer Center for UCB and were analyzed with respect to overall (OS), disease-specific (DSS), and disease-free survival (DFS). Descriptive statistics were used to summarize demographics and perioperative variables. The Kaplan-Meier method was used to estimate survival and recurrence. Univariable and multivariable Cox proportional hazards regression models were used to determine predictors of survival.
Median follow-up was 52 months. Thirty-eight (23.4%) patients received neoadjuvant chemotherapy before RARC; 28% of patients were pT2 and 33% had final pathology status of pT3 or pT4. Median lymph node count was 28, and positive surgical margin rate was 4.3%. Local recurrence occurred in 11 (6.8%) patients. OS, DFS, and DSS at 3 years were 61%, 76%, and 83%, respectively. OS, DFS, and DSS at 5 years were 54%, 74%, and 80%, respectively. Predictors of OS and DFS on multivariable analysis were lymph node density, pathologic stage, and age-adjusted Charlson Comorbidity Index, while receipt of transfusion was also a negative predictor of OS.
RARC provides an effective means of treatment of UCB in a minimally invasive fashion with comparable oncologic outcomes to that reported in the literature of open procedures.
评估大量接受机器人辅助根治性膀胱切除术（RARC）治疗膀胱尿路上皮癌（UCB）患者的中期肿瘤学结果。
2004 年至 2010 年，在希望之城癌症中心有 162 例 UCB 患者接受了 RARC，对其进行了总体生存（OS）、疾病特异性生存（DSS）和无病生存（DFS）分析。使用描述性统计来总结人口统计学和围手术期变量。Kaplan-Meier 法用于估计生存和复发情况。使用单变量和多变量 Cox 比例风险回归模型确定生存预测因素。
中位随访时间为 52 个月。38 例（23.4%）患者在接受 RARC 前接受了新辅助化疗；28%的患者为 pT2，33%的患者最终病理分期为 pT3 或 pT4。中位淋巴结计数为 28 个，切缘阳性率为 4.3%。11 例（6.8%）患者发生局部复发。3 年 OS、DFS 和 DSS 分别为 61%、76%和 83%。5 年 OS、DFS 和 DSS 分别为 54%、74%和 80%。多变量分析中 OS 和 DFS 的预测因素是淋巴结密度、病理分期和年龄调整 Charlson 合并症指数，而输血也是 OS 的负面预测因素。
RARC 以微创方式提供了一种有效的 UCB 治疗方法，其肿瘤学结果与开放手术文献报道的结果相当。
