Gandaglia Giorgio, De Groote Ruben, Geurts Nicolas, D'Hondt Frederiek, Montorsi Francesco, Novara Giacomo, Mottrie Alexandre
1 OLV Vattikuti Robotic Surgery Institute , Melle, Belgium .
2 Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele , Milan, Italy .
J Endourol. 2016 Jan;30(1):75-82. doi: 10.1089/end.2015.0482. Epub 2015 Sep 24.
The aim of our study was to assess the oncologic outcomes of robot-assisted radical cystectomy (RARC) in patients with bladder cancer (BCa) treated in a high-volume robotic center.
We retrospectively collected data of 155 consecutive patients who received RARC for urothelial BCa from January 2004 to May 2014. Kaplan-Meier analyses were used to assess time to recurrence, cancer-specific mortality (CSM) rate, and overall mortality rate. Uni- and multivariable Cox regression models addressed the predictors of recurrence and CSM.
Median follow-up for survivors was 42 months. Overall, 43%, 34%, 55%, and 18% of the patients had pT ≤1, pT2, pT3/4, and pN1-3 disease, respectively. Overall, 76% of the patients had high-grade disease at final pathology. The positive surgical margin rate was 9%. The 5-year recurrence-free, CSM-free, and overall survival estimates were 53.7%, 73.5%, and 65.2%, respectively. Among patients who experienced recurrence, 12.0%, 4.0%, and 84.0% had local, peritoneal, and distant recurrence, respectively. In multivariable Cox regression analyses, pathologic stage and nodal status represented independent predictors of recurrence and CSM (all p ≤ 0.04).
In a high-volume robotic center, RARC provides acceptable oncologic outcomes in patients with urothelial BCa. Tumor stage and nodal status represent independent predictors of recurrence and CSM in this setting.
我们研究的目的是评估在大容量机器人手术中心接受治疗的膀胱癌（BCa）患者行机器人辅助根治性膀胱切除术（RARC）后的肿瘤学结局。
我们回顾性收集了2004年1月至2014年5月期间连续155例行RARC治疗尿路上皮BCa患者的数据。采用Kaplan-Meier分析评估复发时间、癌症特异性死亡率（CSM）和总死亡率。单变量和多变量Cox回归模型分析复发和CSM的预测因素。
幸存者的中位随访时间为42个月。总体而言，分别有43%、34%、55%和18%的患者患有pT≤1、pT2、pT3/4和pN1-3期疾病。总体而言，76%的患者在最终病理检查中患有高级别疾病。手术切缘阳性率为9%。5年无复发生存率、无CSM生存率和总生存率估计分别为53.7%、73.5%和65.2%。在经历复发的患者中，分别有12.0%、4.0%和84.0%发生局部、腹膜和远处复发。在多变量Cox回归分析中，病理分期和淋巴结状态是复发和CSM的独立预测因素（所有p≤0.04）。
在大容量机器人手术中心，RARC为尿路上皮BCa患者提供了可接受的肿瘤学结局。在这种情况下，肿瘤分期和淋巴结状态是复发和CSM的独立预测因素。
