Relapses Rates and Patterns for Pathological T0 after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

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OBJECTIVES: To investigate the oncologic outcomes of pT0 after robot-assisted radical cystectomy (RARC).

METHODS: A retrospective review of the International Robotic Cystectomy Consortium database was performed. Patients with pT0 after RARC were identified and analyzed. Data were reviewed for demographics and pathologic outcomes. Kaplan Meier(KM) curves were used to depict recurrence free survival(RFS), disease specific survival(DSS), and overall survival(OS). Multivariate stepwise Cox regression models were used to identify variables associated with RFS and OS.

RESULTS: 471 patients (18%) with pT0 were identified. Median age was 68 years (IQR 60-73), with a median follow up of 20 months (IQR 6-47). Thirty-seven percent received neoadjuvant chemotherapy (NAC) and 5% had pN+ disease. Seven percent of patients experienced disease relapse; 3% had local and 5% had distant recurrence. Most common sites of local and distant recurrences were pelvis (1%) and lungs (2%). Five-year RFS, DSS, and OS were 88%, 93% and 79%, respectively. Age (HR 1.05, 95% CI 1.01-1.09, p=0.02), pN+ve (HR 11.48, 95%CI 4.47 - 29.49, p<0.01), and reoperations within 30 days (HR 5.53, 95% CI 2.08-14.64, p<0.01) were associated with RFS. Chronic kidney disease (HR 3.24, 95% CI 1.45 - 7.23,p<0.01), neoadjuvant chemotherapy (HR 0.41, 95%CI 0.18-0.92, p=0.03), pN+ve (HR 4.37, 95% CI 1.46-13.06, p<0.01), and reoperations within 30 days (HR 2.64, 95% CI, 1.08 - 6.43, p=0.03) were associated with OS.

CONCLUSIONS: Despite pT0 status at RARC, 5% had pN+ disease and 7% of patients relapsed. Node status was the strongest variable associated with RFS and OS in pT0.

Medical Subject Headings

Aged; Erectile Dysfunction; Humans; Male; Michigan; Middle Aged; Patient Reported Outcome Measures; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Quality of Life; Recovery of Function; Registries; Surveys and Questionnaires

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ePub ahead of print

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