Adjuvant therapy following robot-assisted radical cystectomy for high-risk patients:a real-world study in China
Objective:To investigate and study the application and benefits of adjuvant therapies in Chinese high-risk patients with pT3-pT4 Nany,Tany pN1-3,ypT2-ypT4 Nany or Tany ypN1-3 after robot-assisted radical cystectomy(RARC).Methods:A total of 4 395 patients after RARC at 32 hospitals in China from March 2012 to August 2021 were collected.Then we screened out the high-risk patients and investigated whether they re-ceived adjuvant therapies,what kind of regimen they received and the outcomes of overall survival(OS).At last,we studied the effects of adjuvant therapies on OS.Results:Among the 4 395 post-RARC patients,about 1/3(1 333/4 395)of them were at high risk with pT3-pT4 Nany,Tany pN1-3,ypT2-ypT4 Nany or Tany ypN1-3.Only about 1/3(475/1 333)high-risk patients received adjuvant therapies.The adjuvant therapy regiments were GC(276/475,58.1％),immunotherapy alone(45/475,9.5％),GC combined with immunotherapy(41/475,8.6％)and other adjuvant therapies including non-platinum chemotherapy,radiotherapy and targeted therapy(113/475,23.8％).The difference in OS between the group treated by GC and the group without adjuvant therapies was sta-tistically significant(P=0.013).In the subgroup analysis,there was significant difference in the result of OS be-tween the group treated by GC and the group without adjuvant therapies in N1-3 at N stage and other subgroups(P=0.004).There was no statistically significant difference between the group treated by other regimens and the group without adjuvant therapies(P＞0.05).Conclusion:In China,the proportion of high-risk patients is high,while the proportion of these high-risk patients receiving adjuvant therapies is low.In recent 10 years,GC regimen is used commonly in China.Those high-risk patients who received GC chemotherapy following RARC have surviv-al benefits,especially in the subgroups such as N1-3 at N stage.Whether those high-risk patients benefit from immunotherapy,GC combined with immunotherapy or other adjuvant treatments needs to be further studied.
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