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); (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes.
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 (RFS) and cancer-specific (CSS) survival.
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.
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.
Oncology. 2022 Jun 27 [Epub ahead of print]
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