Peritoneal carcinomatosis and extra-pelvic lymph node metastases can be seen following robot-assisted radical cystectomy (RARC). We report a detailed analysis of RARC patients who developed recurrences in an attempt to identify predictors of these atypical metastases.
310 patients underwent RARC for bladder cancer from 2001 to 2015. Descriptive statistics compared baseline variables between patients without recurrence and those with local, distant or atypical recurrences. Univariate and multivariable regression models assessed the effect of variables on oncological outcomes including recurrence location.
After a median follow-up of 24 months (interquartile range 14-51), 81 patients had a recurrence. In multivariable analysis, tumor classification, lymphovascular invasion, estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73m(2), and perioperative blood transfusion were significantly associated with any recurrence. Specific analyses showed that tumor and nodal classification, lymphovascular invasion, and positive surgical margins were associated with all three recurrence locations (all p <0.05). Previous abdominal surgery was protective against the occurrence of atypical recurrences (hazard ratio 0.36, 95% confidence interval 0.13-0.95; p=0.04). eGFR <60 ml/min per 1.73m(2) and perioperative blood transfusion conferred higher risk of distant or atypical recurrence, but not of local recurrence (all p<0.05). Operative time and previous pelvic radiotherapy were not associated with any recurrence locations.
Predictors of distant recurrences, peritoneal carcinomatosis and extra-pelvic lymph node metastases following RARC were not significantly different and mainly dictated by pathologic tumor characteristics. These results suggest that the risk of atypical recurrence is chiefly influenced by tumor biology rather than surgical aspects.
The Journal of urology. 2016 May 31 [Epub ahead of print]
Daniel P Nguyen, Bashir Al Hussein Al Awamlh, Padraic O'Malley, Farehin Khan, Patrick J E Lewicki, David M Golombos, Douglas S Scherr
Department of Urology, Bern University Hospital, Bern, Switzerland. Electronic address: ., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY.