Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
J Urol. 2016 Nov;196(5):1390-1396. doi: 10.1016/j.juro.2016.05.101. Epub 2016 May 31.
Peritoneal carcinomatosis and extrapelvic lymph node metastases can be seen following robot-assisted radical cystectomy. In an attempt to identify predictors of these atypical metastases we report a detailed analysis of patients treated with robot-assisted radical cystectomy in whom recurrences developed.
A total of 310 patients underwent robot-assisted radical cystectomy for bladder cancer from 2001 to 2015. Descriptive statistics were used to compare baseline variables between patients without recurrence and those with local, distant or atypical recurrence. Univariate and multivariable regression models were used to assess the effect of variables on oncologic outcomes including recurrence location.
At a median followup of 24 months (IQR 14-51) 81 patients had recurrence. On multivariable analysis tumor classification, lymphovascular invasion, estimated glomerular filtration rate less than 60 ml/minute/1.73 m and perioperative blood transfusion were significantly associated with any recurrence. Specific analyses showed that tumor and nodal classification, lymphovascular invasion and positive surgical margins were associated with all 3 recurrence locations (all p <0.05). Previous abdominal surgery was protective against atypical recurrences (HR 0.36, 95% CI 0.13-0.95, p = 0.04). Estimated glomerular filtration rate less than 60 ml/minute/1.73 m and perioperative blood transfusion conferred a higher risk of distant or atypical recurrence but not of local recurrence (all p <0.05). Operative time and previous pelvic radiotherapy were not associated with any recurrence locations.
Predictors of distant recurrences, peritoneal carcinomatosis and extrapelvic lymph node metastases after robot-assisted radical cystectomy did not significantly differ and were mainly dictated by pathological tumor characteristics. Results suggest that the risk of atypical recurrence is chiefly influenced by tumor biology rather than surgical aspects.
机器人辅助根治性膀胱切除术可导致腹膜癌病和盆腔外淋巴结转移。为了确定这些非典型转移的预测因素，我们报告了一项对接受机器人辅助根治性膀胱切除术治疗且复发的患者的详细分析。
2001 年至 2015 年，共有 310 例膀胱癌患者接受机器人辅助根治性膀胱切除术。使用描述性统计比较无复发患者和局部、远处或非典型复发患者的基线变量。使用单变量和多变量回归模型评估变量对包括复发部位在内的肿瘤学结果的影响。
中位随访 24 个月（IQR 14-51）时，81 例患者复发。多变量分析显示，肿瘤分类、脉管侵犯、估计肾小球滤过率小于 60ml/min/1.73m 和围手术期输血与任何复发显著相关。具体分析显示，肿瘤和淋巴结分类、脉管侵犯和阳性切缘与所有 3 种复发部位均相关（均 P<0.05）。既往腹部手术可预防非典型复发（HR 0.36，95%CI 0.13-0.95，P=0.04）。估计肾小球滤过率小于 60ml/min/1.73m 和围手术期输血增加远处或非典型复发的风险，但不增加局部复发的风险（均 P<0.05）。手术时间和既往盆腔放疗与任何复发部位均无关。
机器人辅助根治性膀胱切除术后远处复发、腹膜癌病和盆腔外淋巴结转移的预测因素无显著差异，主要由病理肿瘤特征决定。结果表明，非典型复发的风险主要受肿瘤生物学影响，而非手术方面。
