International journal of urology : official journal of the Japanese Urological Association · 2025
Prognostic Significance of Achieving the Radical Cystectomy-Pentafecta After Neoadjuvant Chemotherapy and Robot-Assisted Radical Cystectomy.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Fukuta Kyotaro, Sasaki Yutaro, Daizumoto Kei, Izumi Kazuyoshi, Kadoriku Fumiya, Utsunomiya Seiya, Shiozaki Keito, Nakashima Takeshi, Fukawa Tomoya, Nakanishi Ryoichi, Izaki Hirofumi, Furukawa Junya
Аннотация
OBJECTIVE: This collaborative, multi-institutional retrospective study aimed to evaluate whether achieving the radical cystectomy-pentafecta contributes to improved outcomes in patients with muscle-invasive bladder cancer undergoing neoadjuvant chemotherapy followed by robot-assisted radical cystectomy.
METHODS: We retrospectively analyzed 195 patients with muscle-invasive bladder cancer who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion at four affiliated institutions. All had a minimum follow-up of 12 months. According to previously established criteria, patients who simultaneously demonstrated (i) negative soft tissue surgical margins, (ii) ≥ 16 lymph node yield, (iii) absence of major complications at 90 days, (iv) absence of urinary diversion-related long-term sequelae, and (v) absence of clinical recurrence in the first year were considered to have achieved the radical cystectomy-pentafecta.
RESULTS: The overall radical cystectomy-pentafecta achievement rate was 46.2% (46.5% in the neoadjuvant chemotherapy group and 45.3% in the no chemotherapy group). In the neoadjuvant chemotherapy group, patients who achieved the radical cystectomy-pentafecta demonstrated significantly better overall survival (p = 0.038), cancer-specific survival (p = 0.009), and recurrence-free survival (p < 0.001) than those who did not.
CONCLUSIONS: The radical cystectomy-pentafecta is a valuable tool to assess the quality of robot-assisted radical cystectomy with intracorporeal urinary diversion. Its achievement may be associated with improved outcomes in patients with muscle-invasive bladder cancer undergoing neoadjuvant chemotherapy prior to surgery.
METHODS: We retrospectively analyzed 195 patients with muscle-invasive bladder cancer who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion at four affiliated institutions. All had a minimum follow-up of 12 months. According to previously established criteria, patients who simultaneously demonstrated (i) negative soft tissue surgical margins, (ii) ≥ 16 lymph node yield, (iii) absence of major complications at 90 days, (iv) absence of urinary diversion-related long-term sequelae, and (v) absence of clinical recurrence in the first year were considered to have achieved the radical cystectomy-pentafecta.
RESULTS: The overall radical cystectomy-pentafecta achievement rate was 46.2% (46.5% in the neoadjuvant chemotherapy group and 45.3% in the no chemotherapy group). In the neoadjuvant chemotherapy group, patients who achieved the radical cystectomy-pentafecta demonstrated significantly better overall survival (p = 0.038), cancer-specific survival (p = 0.009), and recurrence-free survival (p < 0.001) than those who did not.
CONCLUSIONS: The radical cystectomy-pentafecta is a valuable tool to assess the quality of robot-assisted radical cystectomy with intracorporeal urinary diversion. Its achievement may be associated with improved outcomes in patients with muscle-invasive bladder cancer undergoing neoadjuvant chemotherapy prior to surgery.