Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

Yusuke Noda; Taku Naiki; Yosuke Sugiyama; Takashi Nagai; Aya Naiki-Ito; Tatsuya Kawai; Shuzo Hamamoto; Toshiki Etani; Keitaro Iida; Nami Tomiyama; Maria Aoki; Nobuhiko Shimizu; Yoshinobu Moritoki; Hidetoshi Akita; Ryosuke Ando; Noriyasu Kawai; Takahiro Yasui

doi:10.1159/000525554

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis

Oncology. 2022;100(8):429-438. doi: 10.1159/000525554. Epub 2022 Jun 27.

Authors

Yusuke Noda¹, Taku Naiki¹, Yosuke Sugiyama², Takashi Nagai¹, Aya Naiki-Ito³, Tatsuya Kawai⁴, Shuzo Hamamoto¹, Toshiki Etani¹, Keitaro Iida¹, Nami Tomiyama¹, Maria Aoki¹, Nobuhiko Shimizu¹, Yoshinobu Moritoki⁵, Hidetoshi Akita⁵, Ryosuke Ando¹, Noriyasu Kawai¹, Takahiro Yasui¹

Affiliations

¹ Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
² Department of Experimental Pathology and Tumor Biology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
³ Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan.
⁴ Department of Radiology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
⁵ Department of Urology, Anjo Kosei Hospital, Anjo, Japan.

PMID: 35760062
DOI: 10.1159/000525554

Abstract

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.

Keywords: Laparoscopic radical cystectomy; Modified Glasgow prognostic score; Reduced-port surgery.

MeSH terms

Cystectomy / adverse effects
Follow-Up Studies
Humans
Laparoscopy* / methods
Neoplasm Recurrence, Local / surgery
Prognosis
Retrospective Studies
Treatment Outcome
Urinary Bladder Neoplasms* / pathology