Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
Eur Urol. 2014 Nov;66(5):920-8. doi: 10.1016/j.eururo.2014.03.015. Epub 2014 Apr 16.
Long-term oncologic outcomes following robot-assisted radical cystectomy (RARC) remain scarce.
To report long-term oncologic outcomes following RARC at a single institution.
DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective review of 99 patients who underwent RARC for urothelial carcinoma of bladder between 2005 and 2009.
RARC was performed.
Primary outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), measured by the Kaplan-Meier method. The association between primary outcomes and perioperative and pathologic factors was assessed using a multivariable Cox proportional hazards model.
Fifty-one (52%) patients had stage pT3 or higher disease. Eight (8%) patients had positive margins and 30 (30%) had positive lymph nodes (LNs), with a median of 21 LNs removed. Median follow-up for patients alive was 74 mo. The 5-yr RFS, CSS, and OS rates were 52.5%, 67.8%, and 42.4%, respectively. Tumor stage, LN stage, and margin status were each significantly associated with RFS, CSS, and OS. On multivariable analysis, tumor and LN stage were independent predictors of RFS, CSS, and OS, while positive margin status and Charlson comorbidity index predicted worse OS and CSS. Adjuvant chemotherapy predicted RFS only. Retrospective design and lack of open comparison are main limitations of this study.
Long-term oncologic outcomes following RARC demonstrate RFS and CSS estimates similar to those reported in literature for open radical cystectomy. Randomized controlled trials can better define outcomes of any alternative technique.
Survival data 5 yr after RARC for bladder cancer demonstrate that survival outcomes are dependent on the same oncologic parameters as previously reported for open surgery.
机器人辅助根治性膀胱切除术（RARC）后的长期肿瘤学结果仍然很少见。
报告单机构 RARC 的长期肿瘤学结果。
设计、设置和参与者：回顾性分析了 2005 年至 2009 年间 99 例接受 RARC 治疗膀胱癌的患者。
进行 RARC。
主要结局包括无复发生存率（RFS）、癌症特异性生存率（CSS）和总生存率（OS），通过 Kaplan-Meier 方法进行测量。使用多变量 Cox 比例风险模型评估主要结局与围手术期和病理因素之间的关系。
51 例（52%）患者患有 pT3 或更高期别的疾病。8 例（8%）患者切缘阳性，30 例（30%）患者淋巴结阳性（LNs），切除的 LNs 中位数为 21 个。存活患者的中位随访时间为 74 个月。5 年 RFS、CSS 和 OS 率分别为 52.5%、67.8%和 42.4%。肿瘤分期、淋巴结分期和切缘状态与 RFS、CSS 和 OS 均显著相关。多变量分析显示，肿瘤和淋巴结分期是 RFS、CSS 和 OS 的独立预测因素，而阳性切缘状态和 Charlson 合并症指数预测 OS 和 CSS 较差。辅助化疗仅预测 RFS。本研究的主要局限性是回顾性设计和缺乏开放比较。
RARC 后长期肿瘤学结果表明，RFS 和 CSS 估计与文献报道的开放根治性膀胱切除术相似。随机对照试验可以更好地确定任何替代技术的结果。
膀胱癌 RARC 后 5 年的生存数据表明，生存结果取决于与先前报道的开放手术相同的肿瘤学参数。
