AN EMULATION study evaluating 5-year overall survival (OS) following either robotic-assisted radical cystectomy (RARC) or open radical cystectomy (ORC) for bladder urothelial carcinoma showed no significant difference in survival rates.
Researchers, led by Joseph Black, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA, performed an observational analysis to emulate the RAZOR study, which evaluated shorter-term outcomes for patients with urothelial bladder carcinoma treated with RARC or ORC.
The authors reviewed data from 3,493 patients aged 37–89 years diagnosed with tumour clinical stage 1–4, lymph node clinical stage 0–1, metastasis clinical stage 0 urothelial bladder carcinoma between 2010–2015. Patients had Charlson Comorbidity Index (CCI) scores between 0–1 and were followed-up for 29.5 months, on average. Of the total patients, 2,492 underwent ORC with lymph node dissection and 1,001 underwent RARC with lymph node dissection.
The observational analysis revealed that 5-year OS was 55% and 57% in patients who underwent ORC and RARC, respectively (hazard ratio: 0.93; 95% confidence interval: 0.80–1.07; p=0.28). No significant differences were seen in 5-year OS following adjustment for age, tumour clinical stage, and lymph node clinical stage.
In addition to the primary endpoint of 5-year OS, secondary endpoints included perioperative outcomes. The team noted a statistically but not clinically significant higher median lymph node yield at 20 lymph nodes versus 18 lymph nodes (p<0.01), respectively. Positive surgical margin rates in RARC and ORC showed no significant difference at 8% in each group (p=0.64). The team also found that RARC was associated with a shorter admission length than ORC (p<0.01); however, no significant difference was seen in 30-day readmission rates between the two groups at 10% for RARC and 9% for ORC (p=0.80).
The authors concluded that their observational analysis designed to mimic the RAZOR clinical trial found no significant differences in 5-year OS between RARC and ORC.