Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer.
Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer.
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DOI：
10.1016/j.eururo.2015.02.003
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发表时间：
2015-09
期刊：
影响因子：
23.4
通讯作者：
Scherr DS
中科院分区：
文献类型：
--
作者：
Nguyen DP;Al Hussein Al Awamlh B;Wu X;O'Malley P;Inoyatov IM;Ayangbesan A;Faltas BM;Christos PJ;Scherr DS
机器人辅助根治性膀胱癌（RARC）是否会因为肿瘤切除不充分或复发模式的改变而影响生存率，仍令人担忧。描述开放性根治性膀胱癌（ORC）和RARC后的复发模式。回顾性审查了2001年7月至2014年2月在学术机构接受ORC（n = 120）或RARC（n = 263）的383例连续患者。ORC和RARC。使用Kaplan-Meier方法说明无复发生存期估计值。将手术后2年内的复发模式（局部与远端和解剖部位）制成表格。建立考克斯回归模型以评估手术技术对复发风险的影响。ORC组无复发患者的中位随访时间为30个月（四分位距[IQR] 5-72），RARC组为23个月（IQR 9-48）（p = 0.6）。手术2年内，ORC和RARC患者的局部复发数量没有太大差异（15/65 [23%] vs 24/136 [18%]），两组之间局部复发的分布相似。同样，两组间远端复发的数量没有差异（26/73 [36%] vs 43/147 [29%]）。然而，有不同的模式，远处复发。RARC的盆腔外淋巴结位置比ORC更常见（10/43 [23%] vs 4/26 [15%]）。此外，9/43例（21%）RARC患者和2/26例（8%）ORC患者发现腹膜癌病。在多变量分析中，RARC不是复发的预测因子。该研究的局限性包括选择偏倚和有限的样本量。在一定范围内，我们发现RARC不是术后复发的独立预测因子。有趣的是，盆腔外淋巴结位置和腹膜癌转移在RARC患者中比在ORC患者中更常见。需要进一步验证，以更好地理解RAR的肿瘤学意义。在这项研究中，膀胱癌复发的位置以下的传统和机器人技术切除膀胱的描述。虽然数量很小，但结果表明，两种技术之间的远距离递归分布不同。
Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns. To describe recurrence patterns following open radical cystectomy (ORC) and RARC. Retrospective review of 383 consecutive patients who underwent ORC (n = 120) or RARC (n = 263) at an academic institution from July 2001 to February 2014. ORC and RARC. Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence. The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5–72) for ORC and 23 mo (IQR 9–48) for RARC (p = 0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size. Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC. In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques.