Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
Department of Experimental Pathology and Tumor Biology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
Oncology. 2022;100(8):429-438. doi: 10.1159/000525554. Epub 2022 Jun 27.
This study had two objectives: (i) to evaluate oncological outcomes in a long-term follow-up of patients with bladder cancer after reduced-port laparoscopic radical cystectomy (RP-LRC) and (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes.
Consecutive patients (n = 100) who received RP-LRC between March 2012 and December 2018 at our institution and affiliated hospital were retrospectively reviewed. Preoperative serum albumin and C-reactive protein levels were determined. Patients were grouped based on clinical T stage (≤cT2: n = 75, ≥cT3: n = 25) using pooled cumulative data. Oncological outcomes and mGPS as a prognostic biomarker were analyzed retrospectively. Kaplan-Meier curves displayed recurrence and survival rates. Univariate and multivariate Cox regression analyses evaluated potential prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS).
Patient characteristics between the two groups were statistically similar for preoperative hematological and mGPS status, blood loss level, rate of allogeneic transfusion, and pneumoperitoneum time. After a median follow-up period of 55 months, 40/100 patients experienced disease relapse. RFS and CSS for ≤cT2 were significantly less than for ≥cT3 (p < 0.001, p < 0.05, respectively). Distant metastasis occurred in 30 patients with similar distributions of relapse sites between T-stage cohorts. Median RFS for mGPS 1/2 were 18.9 (95% confidence interval [CI]: 8.8-not assessed [NA]) and 35.0 (95% CI: 8.7-NA) months, respectively, significantly worse than for mGPS 0 (median NA, 95% CI: NA-NA); CSS was similar. Univariate and multivariate analyses revealed ≥cT3 stage, worse clinical N stage, and poor mGPS status were significant prognostic factors for short RFS and CSS.
A large proportion of bladder cancer patients who undergo RP-LRC experience relapse, with ≥cT3 stage, worse clinical N stage or poor mGPS status identified as significant prognostic factors. Our findings may contribute to improved surgical procedures for such patients.
本研究有两个目的：（i）评估膀胱癌患者接受腹腔镜根治性膀胱切除术（RP-LRC）后长期随访的肿瘤学结果；（ii）评估改良格拉斯哥预后评分（mGPS）对患者预后的影响。
回顾性分析 2012 年 3 月至 2018 年 12 月在我院及附属医院接受 RP-LRC 的连续患者（n=100）。测定术前血清白蛋白和 C 反应蛋白水平。根据临床 T 分期（≤cT2：n=75，≥cT3：n=25），使用汇总数据对患者进行分组。回顾性分析肿瘤学结果和 mGPS 作为预后生物标志物。Kaplan-Meier 曲线显示复发和生存率。单变量和多变量 Cox 回归分析评估无复发生存率（RFS）和癌症特异性生存率（CSS）的潜在预后因素。
两组患者术前血液学和 mGPS 状态、失血量、同种异体输血率和气腹时间的差异无统计学意义。中位随访 55 个月后，100 例患者中有 40 例发生疾病复发。cT2 患者的 RFS 和 CSS 明显低于 cT3 患者（p<0.001，p<0.05）。远处转移发生在 30 例患者中，T 分期队列的复发部位分布相似。mGPS1/2 的中位 RFS 分别为 18.9（95%置信区间[CI]：8.8-未评估[NA]）和 35.0（95%CI：8.7-NA）个月，明显差于 mGPS0（中位 NA，95%CI：NA-NA）；CSS 相似。单变量和多变量分析显示 cT3 期以上、临床 N 期更差和 mGPS 状态不良是 RFS 和 CSS 较短的显著预后因素。
接受 RP-LRC 的膀胱癌患者中有相当大的比例会复发，cT3 期以上、临床 N 期更差和 mGPS 状态不良被确定为显著的预后因素。我们的研究结果可能有助于为这些患者提供改进的手术治疗。
