Oncologic Outcomes and Predictive Factors for Recurrence Following Robot-Assisted Radical Cystectomy for Urothelial Carcinoma: Multicenter Study from Korea

Abstract

The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7-50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1-20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9-23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1-20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.

Keywords: Bladder Cancer; Outcomes; Radical Cystectomy; Recurrence; Urothelial Carcinoma.

Fig. 1

Distribution of locations among patients with recurrence after RARC. RARC = robot-assisted radical cystectomy, PLND = pelvic lymph node dissection.

Fig. 2

Kaplan-Meier curves for: OS of 93%, 84%, and 78% for 1-, 3-, and 5-year, respectively; CSS of 94%, 87%, and 84% for 1-, 3-, and 5-years, respectively; RFS of 88%, 78%, and 73% for 1-, 3-, and 5-years, respectively. OS = overall survival, CSS = cancer-specific survival, RFS = recurrence-free survival.

Fig. 3

Kaplan-Meier curves for oncologic outcome. (A) RFS at last follow-up for organ-confined vs. non-organ-confined disease was 68% vs. 51%, respectively (P < 0.001); (B) RFS at last follow-up for extended and standard PLND was 70% vs. 47%, respectively (P = 0.038); (C) RFS at last follow-up between LN density was 67%, 41%, and 29%, respectively (P < 0.001); and (D) RFS at last follow-up for negative vs. positive soft tissue margin status was 64% vs. not calculable, respectively (P < 0.001). RFS = recurrence-free survival, PLND = pelvic lymph node dissection, LN = lymph node.