Introduction: 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. Patients and Methods: 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. Results: 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,p= 0.003, 95% CI = 1.196–2.418) and OS (HR = 1.834,p= 0.008, 95% CI = 1.173–2.866). Subgroup analysis demonstrated differences in the T2-or-above subgroup (HR = 1.65;p= 0.004 in DFS and HR = 1.888;p= 0.008 in OS) and the T3-or-above subgroup (HR = 1.757;p= 0.017 in DFS and HR = 1.807;p= 0.034 in OS). Conclusions: 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.
引言：机器人辅助根治性膀胱切除术（RARC）在肌层浸润性膀胱癌（MIBC）的治疗中日益普及。目前对RARC预后影响因素的研究尚不充分。本研究旨在探讨术前肾积水对肿瘤学预后的影响。患者与方法：本研究分析了亚洲RARC联盟（一个涵盖九家亚洲中心的多中心注册数据库）的数据。根据术前是否存在肾积水将病例分为两组。对患者基线特征、手术细节、围手术期结果及肿瘤学结局进行回顾性分析。研究结局包括：（1）生存结局，即10年无病生存率（DFS）和总生存率（OS）；（2）围手术期及病理学结果。对生存结局进行多因素回归分析。结果：2007年至2020年间，共纳入536例接受RARC的非转移性MIBC患者进行分析。其中429例（80.0%）无肾积水，107例（20.0%）存在肾积水。研究发现肾积水是DFS（HR=1.701，p=0.003，95% CI=1.196–2.418）和OS（HR=1.834，p=0.008，95% CI=1.173–2.866）的独立不良预测因素。亚组分析显示，在T2期及以上亚组（DFS：HR=1.65，p=0.004；OS：HR=1.888，p=0.008）和T3期及以上亚组（DFS：HR=1.757，p=0.017；OS：HR=1.807，p=0.034）中均存在显著差异。结论：对于MIBC患者，术前肾积水的存在具有超越肿瘤分期的额外预后价值，其在病例选择中的重要性需予以特别关注。
Pre-Op Hydronephrosis Predicts Outcomes in Patients Receiving Robot-Assisted Radical Cystectomy
肿瘤(癌症)患者之家