Pre-Op Hydronephrosis Predicts Outcomes in Patients Receiving Robot-Assisted Radical Cystectomy

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Robot-assisted radical cystectomy (RARC) is increasingly used for muscle invasive bladder cancer (MIBC).
• Predictors of RARC outcomes require further investigation.
• The prognostic significance of preoperative hydronephrosis in MIBC patients undergoing RARC is not well-established.

Purpose of the Study:

• To investigate the impact of preoperative hydronephrosis on oncological outcomes in patients with MIBC treated with RARC.
• To identify hydronephrosis as a potential prognostic factor in MIBC management.

Main Methods:

• Analysis of data from the Asian RARC consortium, a multicentre registry.
• Categorization of 536 non-metastatic MIBC patients into hydronephrosis (n=107) and no hydronephrosis (n=429) groups.
• Multivariate regression analyses of survival outcomes, including 10-year disease-free survival (DFS) and overall survival (OS).

Main Results:

• Hydronephrosis was present in 20% of analyzed MIBC patients.
• Preoperative hydronephrosis was a significant predictor of inferior DFS (HR=1.701) and OS (HR=1.834).
• Subgroup analyses confirmed these adverse effects in T2-or-above and T3-or-above MIBC stages.

Conclusions:

• Preoperative hydronephrosis has independent prognostic implications for MIBC patients undergoing RARC, beyond established tumor staging.
• The presence of hydronephrosis should be considered in the selection of MIBC patients for RARC.
• Further research into the mechanisms underlying this association is warranted.