机器人辅助肾输尿管切除术：1100余名患者的手术和中期肿瘤学结局（ROBUUST 2.0合作组）

Robot-assisted nephroureterectomy: surgical and mid-term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group)

BJU INTERNATIONAL

影响因子:4.4

分区:医学2区 / 泌尿学与肾脏学2区

发表日期:2024 Dec

作者: Francesco Ditonno, Antonio Franco, Zhenjie Wu, Linhui Wang, Firas Abdollah, Giuseppe Simone, Andres F Correa, Matteo Ferro, Sisto Perdonà, Daniele Amparore, Raj Bhanvadia, Stephan Brönimann, Dhruv Puri, Dinno F Mendiola, Reuben Ben-David, Sol C Moon, Courtney Yong, Farshad S Moghaddam, Alireza Ghoreifi, Eugenio Bologna, Leslie Claire Licari, Marco Finati, Gabriele Tuderti, Emma Helstrom, Marco Tozzi, Antonio Tufano, Soroush Rais-Bahrami, Chandru P Sundaram, Reza Mehrazin, Mark L Gonzalgo, Ithaar H Derweesh, Francesco Porpiglia, Nirmish Singla, Vitaly Margulis, Alessandro Antonelli, Hooman Djaladat, Riccardo Autorino

DOI: 10.1111/bju.16526

摘要

本研究旨在分析机器人辅助肾输尿管切除术（RANU）在当代大型多中心环境中的手术、功能及中期肿瘤学结局。数据来自国际多中心注册数据库ROBUUST 2.0，涵盖2015年至2022年间接受治的上尿路尿路上皮癌患者的资料。分析包括所有连续接受RANU的患者，排除预测变量缺失者。详细记录并分析手术、病理和术后功能数据。肿瘤学时间相关结局包括无复发生存（RFS）、无转移生存（MFS）、癌症特异性生存（CSS）和总体生存（OS）。采用Kaplan-Meier方法进行生存分析，截止3年。建立多变量Cox比例风险模型评估各肿瘤学结局的预测因子。研究共纳入1118例患者。术后并发症发生率为14.1%；阳性切缘率为4.7%。观察到术后估计肾小球滤过率（GFR）中位数（四分位范围）从基线下降-13.1 （-27.5至0） mL/min/1.73 m²。3年RFS为59%，MFS为76%，OS和CSS分别为76%和88%。影响预后不良的显著预测因素包括膀胱袖切除、高级别肿瘤、病理T分期≥3以及淋巴结转移。本研究证实RANU的逐步应用不断增加，显示其具有低手术并发症和良好的中期肿瘤学控制效果，即使在非器官受累疾病中也优于传统开腹肾输尿管切除术。

Abstract

To analyse surgical, functional, and mid-term oncological outcomes of robot-assisted nephroureterectomy (RANU) in a contemporary large multi-institutional setting.Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time-to-event outcomes were: recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, with a 3-year cut-off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome.A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of -13.1 (-27.5 to 0) mL/min/1.73 m2 from baseline was observed. The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder-cuff excision, high-grade tumour, pathological T stage ≥3, and nodal involvement.The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid-term oncological outcomes, mirroring those of open NU, even in non-organ-confined disease.