Analysis Of Prognostic Factors About Da Vinci Robot-assisted Laparoscopic Radical Cystectomy

BackgroundBladder cancer is one of the most common malignant tumors in the urinary system and some patients with bladder cancer need radical cystectomy.Although the diagnosis and treatment strategy of bladder cancer has made great progress,the effect of radical cystectomy is still not ideal,about 50%of the patients had disease progression within 3 years after radical cystectomy,which seriously affect the quality of their lives,even life.It has been found that tumor stage,grade,histological variation,lymph node status,tumor size,expression of biomarkers and preoperative nutritional index are closely related to the prognosis of bladder cancer,but it is still not detailed.The purpose of this study is to analyze the prognostic factors based on the clinicopathological results and follow-up data of patients undergoing Da Vinci robot-assisted radical cystectomy,and to find out the independent prognostic factors of patients after radical cystectomy.This will help to predict individual prognosis,intervene treatment and formulate follow-up strategies.ObjectiveTo discuss and analysis the prognostic factors of bladder cancer after robot-assisted cystectomy and its long term survival,so as to help predict individual prognosis,carry out early intervention treatment,formulate follow-up strategies and provide clinical experience for the diagnosis and treatment of bladder cancer.MethodsTo retrospectively analyze the clinicopathological results and follow-up data of bladder cancer patients diagnosed by pathology in the First Affiliated Hospital of Zhengzhou University from October 1st,2014 to December 31st,2019,a total of 422 cases were included.Kaplan-Meier method was used for univariate survival analysis(Log-rank method was used for significance test)and survival curve was drawn also by it.Multivariable survival analyses were performed by using the Cox proportional hazard regression model to seek the prognostic factors of bladder cancer after radical cystectomy.Define the risk factors into one to four grade groups according to the prognostic factors in order to analyze the survival of different groups and guide clinical strategies.The difference was statistically significant when P<0.05.ResultsA total of 422 patients were included in the study,including 354 males and 68 female patients.The median age was 65 years old,ranging 30 to 86 years old.There were 357 patients finding bladder tumor due to hematuria,47 cases seeking medical advice because of irritation sign of bladder and the rest 18 cases finding bladder tumor by physical examination.All patients underwent Da Vinci robot-assisted laparoscopic radical cystectomy and were routine followed up,of which 393 were interviewed,with an interview rate of 93.1%.The mean follow-up time was 29.3 months(range:0.5 to 75.6 months),during the follow-up time,147(37.4%)of them died,the mean survival time was 49 months(95%CI:45.9 to 52.4 months),9(2.3%)died within 3 months after operation,considering the poor postoperative recovery related to their death,17(4.3%)died of their basic diseases or other diseases,121(30.8%)considered that the bladder tumor progress caused their death.The overall survival rates in 1 year,2 years,3years and 5 years after radical cystectomy were 85.5%,70%,58.5%and 40.5%respectively,the tumor specific survival rates at 1 year,2 years,3 years and 5 years after operation were 89.9%,73.9%,61.4%and 43.6%respectively and around 54 months after operation,the overall survival curve tended to be gentle.Univariate analysis showed that age,preoperative hydronephrosis,urinary diversion mode,pathological grade,vascular system tumor thrombus,tumor nerve invasion,pathological T stage,regional lymph node status,preoperative NLR,LMR,PLR and PNI were the prognostic factors;Multivariate analysis showed that age,preoperative hydronephrosis,pathological T staging,lymph node status and preoperative prognosis nutritional index were independent prognostic factors for patients with bladder cancer(P<0.05).The mean survival time of patients without or with one independent prognostic factors after robot-assisted laparoscopic radical cystectomy was 71.5 months(95%CI:68.1 to 75.0 months),patients with any two independent risk factor had an average survival time of 58.7 months(95%CI:53.3 to 64.2 months),the mean survival time of patients with any three independent factors was 41.2 months(95%CI:34.9 to 47.4 months),the mean survival time of patients with four or more independent factors was 28.7 months(95%CI:21.9 to 35.5 months).Conclusions1.Hematuria is the primary clinical manifestation of bladder cancer.It has no significant connection with the prognosis of patients.After radical cystectomy,the overall prognosis is poor,and should be closely followed up within 54 months after operation.2.The overall survival rates of 1 years,2 years,3 years and 5 years after robot-assisted radical cystectomy were 85.5%,70%,58.5%and 40.5%respectively.The tumor specific survival rates in 1 year,2 years,3 years and 5 years were 89.9%,73.9%,61.4%and 43.6%respectively.3.Univariate and multivariate analysis showed that age,preoperative hydronephrosis,pathological T stage,regional lymph node status and preoperative prognostic nutritional index were independent prognostic factors after robot-assisted radical cystectomy.4.Patients with no independent risk factors after robot-assisted radical cystectomy had a better prognosis,combined two or more independent risk factors had poor prognosis.