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Area of Science:

  • Urology
  • Oncology
  • Robotic Surgery

Background:

  • Robot-assisted radical cystectomy (RARC) is increasingly used for bladder cancer treatment.
  • Pathologic T0 (pT0) status after RARC indicates no residual tumor in the bladder specimen.
  • Understanding the long-term oncologic outcomes for patients achieving pT0 is crucial for treatment stratification.

Purpose of the Study:

  • To investigate the oncologic outcomes, including recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS), in patients who achieved pT0 status after RARC.
  • To identify factors associated with adverse oncologic outcomes in the pT0 cohort.

Main Methods:

  • A retrospective review of the International Robotic Cystectomy Consortium database.
  • Identification and analysis of patients with pT0 following RARC.
  • Kaplan-Meier survival analysis for RFS, DSS, and OS.
  • Multivariate Cox regression to determine predictors of RFS and OS.

Main Results:

  • 471 patients (18%) achieved pT0 status post-RARC.
  • Median follow-up was 20 months.
  • Five-year RFS, DSS, and OS were 88%, 93%, and 79%, respectively.
  • Factors associated with RFS included age, pN+ disease, and reoperations within 30 days.
  • Factors associated with OS included chronic kidney disease, neoadjuvant chemotherapy, pN+ disease, and reoperations within 30 days.

Conclusions:

  • Achieving pT0 status after RARC is associated with favorable survival rates.
  • However, a small percentage of patients with pT0 disease still experience recurrence or have positive nodes (pN+).
  • Node status (pN+) emerged as the strongest predictor for both RFS and OS in the pT0 cohort, highlighting the importance of accurate lymph node assessment.