Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches
Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches
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膀胱癌根治性膀胱切除术后的生存率：微创和开放手术之间的多中心比较
DOI：
10.1016/j.ajur.2020.06.002
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发表时间：
2020-07-01
影响因子：
2.6
通讯作者：
Huang, Jian
中科院分区：
文献类型：
--
作者：
Xie, Weibin;Bi, Junming;Huang, Jian
目的：调查接受微创根治性膀胱切除术 (MIRC) 或开放根治性膀胱切除术 (ORC) 的膀胱癌患者的肿瘤学结果。方法：我们在中国膀胱癌联盟 (CBCC) 的 13 个中心确定了接受根治性膀胱切除术 (RC) 的膀胱癌患者。比较 MIRC 和 ORC 的围手术期结果。通过时序检验评估了整个研究组和根据病理分期或淋巴结 (LN) 状态分类的亚组中手术方法对总生存期 (OS) 和癌症特异性生存期 (CSS) 的影响。采用多变量Cox比例风险模型评估OS、CSS和相关危险因素之间的关联。结果：在2 098例接受RC的患者中，1 243例患者接受了MIRC（分别为1 087例腹腔镜RC和156例机器人辅助RC），而855例患者接受了ORC。手术切缘阳性率和术后 90 天死亡率没有显着差异。 MIRC 与较少的估计失血量、较多的 LN 产量、较高的新膀胱改道率、较长的手术时间和较长的住院时间相关。根据手术方式的不同，OS 和 CSS 没有显着差异（分别为 pZ0.653 和 0.816）。亚组分析显示，无论膀胱外受累或淋巴结受累状态如何，OS 和 CSS 均无显着差异。多变量 Cox 回归分析表明，手术方式并不是 OS 和 CSS 的显着预测因素。结论：我们的研究表明，MIRC 在 OS 和 CSS 方面与传统 ORC 相当。 (C) 2020年《亚洲泌尿外科杂志》编辑部。由 Elsevier B.V 制作和托管。这是一篇遵循 CC BY-NC-ND 许可证 (http://creativecommons.org/licenses/by-nc-nd/4.0/) 的开放获取文章。
Objective: To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC).Methods: We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest.Results: Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches (pZ0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions: Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS. (C) 2020 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).