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Titel: Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy : Results from the International Robotic Cystectomy Consortium
VerfasserIn: Iqbal, Umar
Elsayed, Ahmed S.
Jing, Zhe
Stöckle, Michael
Wijburg, Carl
Wiklund, Peter
Hosseini, Abolfazl
Dasgupta, Prokar
Khan, Mohammad Shamim
Hemal, Ashok
Kim, Eric
Wagner, Andrew A.
Gaboardi, Franco
Rha, Koon Ho
Maatman, Thomas J.
Balbay, Derya
Li, Qiang
Hussein, Ahmed A.
Guru, Khurshid A.
Sprache: Englisch
Titel: Journal of Endourology
Bandnummer: 35
Heft: 10
Verlag/Plattform: Mary Ann Liebert
Erscheinungsjahr: 2021
Freie Schlagwörter: upstaging
robot-assisted
radical cystectomy
non-muscle invasive
bladder cancer
pathologic discrepancy
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: Introduction: We sought to describe the incidence, risk factors, and survival outcomes associated with pathologic upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). Methods: We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pathologic node positive (pN+) at final pathology analysis from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran–Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan–Meier curves were used to describe disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS). Results: A total of 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p < 0.01), more likely to have American Society of Anesthesiologists (ASA) score (≥3; 55% vs 44%, p = 0.04), and had higher rate of preoperative hydronephrosis (26% vs 10%, p < 0.01). They were more likely to have positive surgical margins (10% vs 3%, p = 0.01), recurrences (28% vs 9%, p < 0.01), and to receive adjuvant/salvage treatment (26% vs 3%, p < 0.01). On multivariate analysis, upstaging was associated with older age (odds ratio [OR] 1.04; confidence interval [CI] 1.01–1.07, p < 0.01), cT1vs cTis (OR 4.25; CI 1.57–11.48, p < 0.01), cT1vs cTa (OR 2.92; CI 1.40–6.06, p < 0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60–6.32, p < 0.01). Upstaged patients had worse 5-year RFS (53% vs 85%, log rank p < 0.01), DSS (66% vs 93%, log rank p < 0.01), and OS (49% vs 74%, log rank p < 0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p = 0.17). Conclusion: Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.
DOI der Erstveröffentlichung: 10.1089/end.2021.0013
URL der Erstveröffentlichung: https://www.liebertpub.com/doi/pdf/10.1089/end.2021.0013
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-378004
hdl:20.500.11880/34185
http://dx.doi.org/10.22028/D291-37800
ISSN: 1557-900X
0892-7790
Datum des Eintrags: 3-Nov-2022
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Urologie und Kinderurologie
Professur: M - Prof. Dr. Michael Stöckle
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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