Wong Chris Ho-Ming, Ko Ivan Ching-Ho, Leung David Ka-Wai, Kang Seok Ho, Kitamura Kousuke, Horie Shigeo, Muto Satoru, Ohyama Chikara, Hatakeyama Shingo, Patel Manish, Yang Cheung-Kuang, Kijvikai Kittinut, Lee Ji Youl, Chen Hai-Ge, Zhang Rui-Yun, Lin Tian-Xin, Lee Lui Shiong, Teoh Jeremy Yuen-Chun, Chan Eddie
S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Department of Urology, Korea University Anam Hospital, Seoul 02841, Republic of Korea.
Cancers (Basel). 2024 Aug 12;16(16):2826. doi: 10.3390/cancers16162826.
Robot-assisted radical cystectomy (RARC) has gained momentum in the management of muscle invasive bladder cancer (MIBC). Predictors of RARC outcomes are not thoroughly studied. We aim to investigate the implications of preoperative hydronephrosis on oncological outcomes.
This study analysed data from the Asian RARC consortium, a multicentre registry involving nine Asian centres. Cases were divided into two groups according to the presence or absence of pre-operative hydronephrosis. Background characteristics, operative details, perioperative outcomes, and oncological results were reviewed. Outcomes were (1) survival outcomes, including 10-year disease-free survival (DFS) and overall survival (OS), and (2) perioperative and pathological results. Multivariate regression analyses were performed on survival outcomes.
From 2007 to 2020, 536 non-metastatic MIBC patients receiving RARC were analysed. 429 had no hydronephrosis (80.0%), and 107 (20.0%) had hydronephrosis. Hydronephrosis was found to be predictive of inferior DFS (HR = 1.701, = 0.003, 95% CI = 1.196-2.418) and OS (HR = 1.834, = 0.008, 95% CI = 1.173-2.866). Subgroup analysis demonstrated differences in the T2-or-above subgroup (HR = 1.65; = 0.004 in DFS and HR = 1.888; = 0.008 in OS) and the T3-or-above subgroup (HR = 1.757; = 0.017 in DFS and HR = 1.807; = 0.034 in OS).
The presence of preoperative hydronephrosis among MIBC patients carries additional prognostic implications on top of tumour staging. Its importance in case selection needs to be highlighted.
机器人辅助根治性膀胱切除术（RARC）在肌肉浸润性膀胱癌（MIBC）的治疗中得到了广泛应用。RARC治疗效果的预测因素尚未得到充分研究。我们旨在探讨术前肾积水对肿瘤学治疗效果的影响。
本研究分析了亚洲RARC联盟的数据，该联盟是一个涉及9个亚洲中心的多中心登记处。根据术前是否存在肾积水将病例分为两组。回顾了患者的背景特征、手术细节、围手术期结果和肿瘤学结果。观察指标包括：（1）生存结果，包括10年无病生存率（DFS）和总生存率（OS）；（2）围手术期和病理结果。对生存结果进行多因素回归分析。
2007年至2020年，共分析了536例接受RARC治疗的非转移性MIBC患者。429例无肾积水（80.0%），107例（20.0%）有肾积水。结果发现，肾积水是DFS较差（HR = 1. ; = 0.003, 95% CI = 1.196 - 2.418）和OS较差（HR = 1.834, = 0.008, 95% CI = 1.173 - 2.866）的预测因素。亚组分析显示，T2及以上亚组（DFS的HR = 1.65; = 0.004，OS的HR = 1.888; = 0.008）和T3及以上亚组（DFS的HR = 1.757; = 0.017，OS的HR = 1.807; = 0.034）存在差异。
MIBC患者术前存在肾积水除了对肿瘤分期有影响外，还具有额外的预后意义。需要强调其在病例选择中的重要性。
