机器人辅助根治性膀胱切除术联合体内尿流改道术与开放性根治性膀胱切除术治疗膀胱癌的疗效比较
Comparative effectiveness of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy for bladder cancer.
作者信息
Gabriel Pierre-Etienne, Pinar Ugo, Lenfant Louis, Parra Jérôme, Vaessen Christophe, Mozer Pierre, Chartier-Kastler Emmanuel, Rouprêt Morgan, Seisen Thomas
机构信息
GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, Paris, France.
出版信息
BJU Int. 2025 Mar;135(3):517-527. doi: 10.1111/bju.16565. Epub 2024 Oct 21.
OBJECTIVES
To assess the comparative effectiveness of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) vs open radical cystectomy (ORC) for bladder cancer (BC).
PATIENTS AND METHODS
We conducted a real-life monocentric study including all consecutive patients who underwent RARC with ICUD or ORC for BC at our institution from 2014 to 2023. Uni- and multivariable logistic and Cox regression analyses were used to compare perioperative, oncological and stricture outcomes between both groups by calculating odds (ORs) and hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs), respectively.
RESULTS
Overall, 316 patients underwent either RARC with ICUD (n = 228 [72.2%]) or ORC (n = 88 [27.8%]). The perioperative benefits of RARC vs ORC included decreased risks of major blood loss (OR 0.10, 95% CI 0.04-0.23; P < 0.001), perioperative transfusion (OR 0.30, 95% CI 0.16-0.57; P < 0.001), 90-day major complications (OR 0.56, 95% CI 0.29-0.99; P = 0.04), and prolonged initial length of hospital stay (OR 0.20, 95% CI 0.09-0.35; P < 0.001), as well as more days alive and out of the hospital within 90 days of surgery (OR 2.56, 95% CI 1.46-4.6; P < 0.01). In addition, the use of RARC vs ORC was associated with a higher lymph node (LN) count (OR 3.35, 95% CI 1.83-6.30; P < 0.001), while there was no significant difference in recurrence-free (HR 0.72, 95% CI 0.49-1.07; P = 0.1), cancer-specific (HR 0.69, 95% CI 0.43-1.10; P = 0.1), overall (HR 0.76, 95% CI 0.47-1.20; P = 0.3) and uretero-ileal stricture-free (HR 1.18, 95% CI 0.62-2.25; P = 0.6) survival between both groups after a median (interquartile range) follow-up of 42.3 (16.4-73.8) months.
CONCLUSION
Our real-world study supports the effectiveness of RARC with ICUD vs ORC for BC. We generally observed better perioperative outcomes, as well as similar oncological-except for higher LN count-and uretero-ileal stricture outcomes after RARC with ICUD vs ORC.
目的
评估机器人辅助根治性膀胱切除术（RARC）联合体内尿流改道术（ICUD）与开放性根治性膀胱切除术（ORC）治疗膀胱癌（BC）的相对疗效。
患者与方法
我们进行了一项真实世界的单中心研究，纳入了2014年至2023年在我们机构接受RARC联合ICUD或ORC治疗BC的所有连续患者。采用单变量和多变量逻辑回归及Cox回归分析，通过分别计算优势比（OR）和风险比（HR）及其相应的95%置信区间（CI），比较两组患者的围手术期、肿瘤学和狭窄相关结局。
结果
总体而言，316例患者接受了RARC联合ICUD（n = 228 [72.2%]）或ORC（n = 88 [27.8%]）治疗。与ORC相比，RARC的围手术期益处包括大出血风险降低（OR 0.10，9５% CI 0.04 - 0.23；P < 0.001）、围手术期输血风险降低（OR 0.30，95% CI 0.16 - 0.57；P < 0.001）、90天内严重并发症风险降低（OR 0.56，95% CI 0.29 - 0.99；P = 0.04）、初始住院时间延长风险降低（OR 0.20，95% CI 0.09 - 0.35；P < 0.001），以及术后90天内存活且出院天数增加（OR 2.56，95% CI 1.46 - 4.6；P < 0.01）。此外，与ORC相比，RARC的淋巴结（LN）计数更高（OR 3.35，95% CI 1.83 - 6.30；P < 0.001），而两组患者的无复发生存率（HR 0.72，95% CI 0.49 - 1.07；P = 0.1）、癌症特异性生存率（HR 0.69，95% CI 0.43 - 1.10；P = 0.1）、总生存率（HR 0.76，95% CI 0.47 - 1.20；P = 0.3）和输尿管 - 回肠无狭窄生存率（HR 1.18，95% CI 0.62 - 2.25；P = 0.6）在中位（四分位间距）随访42.3（16.4 - 73.8）个月后无显著差异。
结论
我们的真实世界研究支持RARC联合ICUD对比ORC治疗BC的有效性。我们总体观察到，与ORC相比，RARC联合ICUD术后围手术期结局更好，肿瘤学结局相似（除LN计数更高外），输尿管 - 回肠狭窄结局相似。
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