The randomized open versus robotic cystectomy (RAZOR) trial reported non-inferior 2-year progression-free survival (PFS) for robotic radical cystectomy (RARC). This update was performed with extended follow-up for 3 years to demonstrate potential differences between the approaches. We also report 3-year overall survival (OS) and aim to identify factors predicting recurrence, PFS and OS.The per-protocol population of 302 patients from RAZOR study was analyzed. Cumulative recurrences were estimated using non-bladder cancer death as the competing risk event and Gray's test was used to assess significance in differences. PFS and OS were estimated by Kaplan-Meier method and compared using the log rank test. Predictors of outcomes were determined by Cox proportional hazard analysis.Estimated PFS at 36 months was 68.4% (95% CI 60.1-75.3%) and 65.4% (95% CI 56.8-72.7%) in the robotic and open groups respectively (p=0.600). OS at 36 months was 73.9% (95% CI 65.5-80.5%) and 68.5% (95% CI 59.8-75.7%) for the robotic and open group respectively (p=0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.802). Age >70 years, poor performance status and major complications were significant predictors of PFS and OS. Stage and positive margins were significant predictors of recurrence, PFS and OS. Surgical approach was not a significant predictor of any outcome.This analysis shows no difference in recurrence, 3-year PFS and 3-year OS between RARC and ORC. It provides important prospective data on the oncologic efficacy of RARC and high-level data for patient counseling.
View details for DOI 10.1097/JU.0000000000000565
View details for PubMedID 31549935