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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 698-705. doi: 10.19723/j.issn.1671-167X.2019.04.018

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Propensity-matched comparison of laparoscopic and open radical cystectomy for female patients with bladder cancer

Hai-wen HUANG1,Bing YAN2,Mei-xia SHANG3,Li-bo LIU1,Han HAO1,Zhi-jun XI1,△()   

  1. 1.Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, Xingtai People’s Hospital, Xingtai 054001, Hebei, China
    3. Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China
  • Received:2019-03-20 Online:2019-08-18 Published:2019-09-03
  • Contact: Zhi-jun XI E-mail:xizhijun@hsc.pku.edu.cn
  • Supported by:
    Supported by the National Natural Science Foundation of China(81272829)

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Abstract:

Objective: To compare the perioperative and oncologic outcomes of female patients recei-ving laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC).Methods: Retrospective review of 91 consecutive female patients with urothelial carcinoma of bladder undergoing radical cystectomy at a single academic institution from 2006 to 2017. Those female patients received open radical cystectomy were matched to the patients who underwent laparoscopic radical cystectomy by using propensity score matching in 1 :1 ratio. The matching factors included age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, pathologic stage and pathologic nodal stage. The periope-ration and oncology characteristics were compared, and Kaplan-Meier method was used to analyze the overall survival (OS), cancer specific survival (CSS) and progression-free survival (PFS) estimates. Finally, we did a sensitive analysis by using multivariable COX regression of all the patients, adjusting for the matching factors.Results: There were 65 ORC and 26 LRC patients identified in this cohort with urothelial carcinoma of bladder, the median follow-up time was 38 months (interquartile range 18-69). The age (P<0.001) and ASA scores (P=0.018) were less for LRC before being matched. There were 22 LRC and 22 ORC patients matching successfully. Before being matched, the estimate blood loss (P=0.005), transfusion rate (P<0.001) and total complications rate (P=0.015) were less for LRC, and the lymph nodes yield was greater for LRC, but there were no differences in OS (P=0.698), CSS (P=0.942) and PFS (P=0.837) between the two groups. After being matched, the estimate blood loss (P=0.009), transfusion rate (P=0.001) and total complications rate (P=0.040) were less for LRC, but there was no difference in the lymph nodes yield. Besides, there were no statistic differences in OS (P=0.432), CSS (P=0.429) and PFS (P=0.284) between the two groups. In addition, in multivariable COX regression analysis, surgical approaches (LRC/ORC) were not found to be a predictor of OS (HR 1.134, 95%CI 0.335-3.835, P=0.839), CSS (HR 1.051, 95%CI 0.234-4.719, P=0.949) and PFS (HR 0.538, 95%CI 0.138-2.095, P=0.371) of the female patients with urothelial carcinoma of bladder.Conclusion: It is advantageous for laparoscopic radical cystectomy in terms of estimating blood loss, transfusion rate and complication rate. But there was no evidence that laparoscopic radical cystectomy for female patients with bladder cancer had a better oncologic prognosis than open radical cystectomy from this study.

Key words: Urinary bladder neoplasms, Women, Laparoscopy, Cystectomy, Propensity-score matching

CLC Number: 

  • R737.14

Table 1

Baseline characteristics of patients received ORC or LRC before PSM matched and after PSM matched"

Items Before matched After matched
ORC (n=65) LRC (n=26) P ORC (n=22) LRC (n=22) P
Age/years 71 (63-75) 62 (53-67) <0.001b 66±11 63±9 0.343a
BMI/(kg/m2) 23.73 (21.67-26.45) 23.17 (21.78-26.67) 0.836b 24.94±3.84 24.63±3.47 0.779a
ASA score, n(%) 0.018b 0.260b
1 2 (3.1) 4 (15.4) 1 (4.5) 2 (9.1)
2 53 (81.5) 21 (80.8) 18 (81.8) 19 (86.4)
3 10 (15.4) 1 (3.8) 3 (13.6) 1 (4.5)
T stage, n(%) 0.707b 0.786b
Ta and Tis and T1 16 (24.6) 7 (26.9) 4 (18.2) 7 (31.8)
T2 29 (44.6) 9 (34.6) 11 (50) 7 (31.8)
T3 15 (23.1) 7 (26.9) 5 (22.7) 5 (22.7)
T4 5 (7.7) 3 (11.5) 2 (9.1) 3 (13.6)
N stage, n(%) 0.256c 0.607c
N- 54 (83.1) 24 (92.3) 19 (86.4) 21 (95.5)
N+ 11(16.9) 2 (7.7) 3 (13.6) 1 (4.5)

Table 2

The perioperative and pathological characteristics of patients received ORC or LRC before PSM matched and after PSM matched"

Items Before matched After matched
ORC (n=65) LRC (n=26) P ORC (n=22) LRC (n=22) P
Type of urinary diversion, n(%) 0.001c 0.321c
Cutaneous ureterostomy 26 (40.0) 4 (15.4) 7 (31.8) 4 (18.2)
Ileal conduit 39 (60.0) 17 (65.4) 15 (68.2) 16 (72.7)
Orthotopic neobladder 0 5 (19.2) 0 2 (9.1)
Time of operation/min 272 (207-378) 318.5 (270-402) 0.125b 302.36±101.38 308.73±80.88 0.819a
Bleeding volume during operation/L 500 (300-800) 300 (100-500) 0.005b 550 (300-800) 300 (100-500) 0.009b
Intraoperative transfusion, n(%) 43 (66.2) 6 (23.1) <0.001c 15 (68.2) 4 (18.2) 0.001c
Complication, n(%) 49 (75.4) 13 (50.0) 0.015c 17 (77.3) 11 (50) 0.040c
Clavein Ⅰ 1 (1.5) 1 (3.8) 0 1 (4.5)
Clavein Ⅱ 47 (72.3) 11 (42.3) 17 (77.3) 9 (40.9)
Clavein Ⅲ 0 0 0 0
Clavein Ⅳ 0 1 (3.8) 0 1 (4.5)
Clavein Ⅴ 1 (1.5) 0 0 0
Postoperative stay/d 10 (8-14) 9 (7-14) 0.184b 9 (8-12) 8 (7-11) 0.314b
Postoperative fasting time/d 4 (3-6) 5 (4-6) 0.222b 4.5 (4-6) 5 (4-5) 0.990b
Lymphy node yield 9 (6-14) 11 (9-15) 0.035b 11 (7-14) 11 (8-14) 0.472b
Pathologic grade, n(%) 0.723c 0.664c
Low grade 7 (10.8) 4 (15.4) 2 (9.1) 4 (18.2)
High grade 58 (89.2) 22 (84.6) 20 (90.9) 18 (81.8)
Margin, n(%)
Negative 65 (100) 24 (92.3) 0.079c 22 (100) 20 (90.9) 0.488c
Positive 0 2 (7.7) 0 2 (9.1)
Neoadjuvant/adjuvant chemotherapy, n(%)
No 57 (87.7) 23 (88.5) 1.000c 19 (86.4) 19 (86.4) 1.000c
Yes 8 (12.3) 3 (11.5) 3 (13.6) 3 (13.6)

Figure 1

Kaplan-Meier curves of overall survival probability (A),cancer specific survival (B) and progression-free survival probability (C) in patients received LRC and ORC before PSM matched"

Figure 2

Kaplan-Meier curves of overall survival probability (A),cancer specific survival (B) and progression-free survival probability (C) in patients received LRC and ORC after PSM matched"

Table 3

Univariable and multivariable Cox regression analysis of variables associated with overall survival for patients received cystectomy before PSM matched"

Variable Univariable COX regression analysis Multivariable COX regression analysis
HR 95%CI P HR 95%CI P
Age (continuous) 1.036 0.992-1.082 0.115 1.044 0.985-1.106 0.145
BMI (continuous) 1.013 1.003-1.022 0.007 1.013 1.001-1.025 0.032
ASA score
1 and 2 - Referent - - Referent -
3 1.423 0.487-4.155 0.519 1.059 0.322-3.478 0.925
Pathologic stage 0.022 0.350
Ta and Tis and T1 - Referent - - Referent -
T2 1.000 0.343-2.914 0.999 0.784 0.250-2.463 0.677
T3 1.351 0.435-4.202 0.603 0.967 0.282-3.314 0.957
T4 5.127 1.523-17.260 0.008 3.239 0.692-15.159 0.136
Pathologic nodal stage
N0 - Referent - - Referent -
N+ 3.477 1.431-8.445 0.006 1.482 0.387-5.668 0.566
ORC - Referent - - Referent -
LRC 0.823 0.307-2.210 0.700 1.134 0.335-3.835 0.839

Table 4

Univariable and multivariable Cox regression analysis of variables associated with cancer specific survival for patients received cystectomy before PSM matched"

Variable Univariable COX regression analysis Multivariable COX regression analysis
HR 95%CI P HR 95%CI P
Age (continuous) 1.018 0.969-1.071 0.474 1.005 0.941-1.074 0.881
BMI (continuous) 1.016 1.006-1.026 0.002 1.013 1.000-1.026 0.050
ASA score
1 and 2 - Referent - - Referent -
3 1.032 0.236-4.522 0.967 1.144 0.224-5.850 0.872
Pathologic stage 0.022 0.428
Ta and Tis and T1 - Referent - - Referent -
T2 2.546 0.520-12.456 0.249 2.794 0.533-14.646 0.224
T3 2.692 0.492-14.732 0.253 2.159 0.347-13.435 0.409
T4 11.750 2.087-66.157 0.005 5.196 0.710-38.048 0.105
Pathologic nodal stage
N0 - Referent - - Referent -
N+ 5.991 2.246-15.985 <0.001 3.674 0.860-15.692 0.079
ORC - Referent - - Referent -
LRC 0.959 0.310-2.964 0.942 1.051 0.234-4.719 0.949

Table 5

Univariable and multivariable Cox regression analysis of variables associated with progression free survival for patients received cystectomy before PSM matched"

Variable Univariable COX regression analysis Multivariable COX regression analysis
HR 95%CI P HR 95%CI P
Age (continuous) 1.028 0.978-1.080 0.275 1.033 0.968-1.103 0.325
BMI (continuous) 1.013 1.004-1.022 0.005 1.010 0.998-1.022 0.116
ASA score
1 and 2 - Referent - - Referent -
3 0.864 0.199-3.742 0.845 0.778 0.159-3.798 0.778
Pathologic stage 0.023 0.416
Ta and Tis and T1 - Referent - - Referent -
T2 2.050 0.534-7.869 0.296 2.049 0.500-8.398 0.319
T3 1.896 0.422-8.514 0.404 1.437 0.282-7.331 0.663
T4 9.376 2.011-43.720 0.004 4.513 0.717-28.393 0.108
Pathologic nodal stage
N0 - Referent - - Referent -
N+ 5.336 2.081-13.686 <0.001 3.332 0.797-13.936 0.099
ORC - Referent - - Referent -
LRC 1.114 0.397-3.120 0.838 0.538 0.138-2.095 0.371
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