Survival outcome after reduced-port laparoscopic radical cystectomy for bladder cancer: long-term follow-up analysis
Survival outcome after reduced-port laparoscopic radical cystectomy for bladder cancer: long-term follow-up analysis
复制标题
膀胱癌缩孔腹腔镜根治性膀胱切除术后的生存结果：长期随访分析
作者：
Noda Yusuke;Naiki Taku;Sugiyama Yosuke;Nagai Takashi;Naiki-Ito Aya;Kawai Tatsuya;Hamamoto Shuzo;Etani Toshiki;Iida Keitaro;Tomiyama Nami;Aoki Maria;Shimizu Nobuhiko;Moritoki Yoshinobu;Akita Hidetoshi;Ando Ryosuke;Kawai Noriyasu;Yasui Takah
引言：本研究有两个目标：（i）评估膀胱癌患者行缩口腹腔镜根治性膀胱切除术（RP-LRC）后长期随访的肿瘤学结局;（ii）评估改良格拉斯哥预后评分（mGPS）对患者结局的影响。方法：回顾性分析2012年3月至2018年12月期间在我院及附属医院接受RP-LRC治疗的100例患者。术前测定血清白蛋白和C反应蛋白水平。使用汇总累积数据，根据临床T分期（≤ cT 2：n= 75，≥ cT 3：n= 25）对患者进行分组。回顾性分析肿瘤学结局和作为预后生物标志物的mGPS。Kaplan-Meier曲线显示复发率和生存率。单变量和多变量考克斯回归分析评估了无复发生存期（RFS）和癌症特异性生存期（CSS）的潜在预后因素。结果：两组患者的术前血液学和mGPS状态、失血量、异体输血率和气腹时间在统计学上相似。中位随访期为55个月后，40/100例患者出现疾病复发。≤ cT 2的RFS和CSS显著低于≥ cT 3（分别为p<0.001，p < 0.05）。30例患者发生远处转移，T分期队列之间复发部位分布相似。mGPS 1/2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，显著差于mGPS 0（中位NA，95% CI：NA-NA）; CSS相似。单因素和多因素分析显示，≥ cT 3阶段，更糟糕的临床N阶段，和穷人的mGPS状态是显着的预后因素短RFS和CSS.Conclusions：一个大比例的膀胱癌患者接受RP-LRC经验复发，与≥ cT 3阶段，更糟糕的临床N阶段或穷人的mGPS状态确定为显着的预后因素。我们的研究结果可能有助于改善此类患者的外科手术。
Introduction: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.Methods: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).Results: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.Conclusions: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.