Robot-assisted radical cystectomy,
does it really help with Noninferior two-year progression-free survival in bladder cancer?
research showsGrade B, 76 points. In 302 per-protocol patients, two-year PFS was 72.3% versus 71.6%, absolute difference 0.7 points (95% CI -9.6 to 10.9). The lower limit exceeded the prespecified -15-point margin. Superiority and cost savings were not established.
ads claimNoninferiority is not superiority or cost-effectiveness. Robotic surgery is common in Korea, but patient costs vary substantially.
Useful facts when choosing a product
- All urinary diversions in RAZOR were extracorporeal.
- Korean out-of-pocket robotic surgery costs vary by institution and coverage.
What the research actually shows
Four-gate review: ① Noninferiority design ② listed item ③ margin -15 points; difference 0.7 (95% CI -9.6 to 10.9) crossed it ④ avoidable through a superiority design, so counted. ① Completer analysis ② listed item ③ prespecified PP included 302 operated protocol-adherent patients, with mITT for consistency ④ conservative standard PP analysis for noninferiority, so not separately counted. ① At least 15% attrition ② listed item ③ 48/350=13.7% excluded ④ below threshold. ① Unmasked subjective endpoint ② listed item ③ open surgery but radiographic/pathologic progression and death, with pathologists masked ④ objective endpoint, criterion not met.
Why this is classified as B (76)
This 350-person large hard-outcome publicly funded RCT gives B, 76. Bias remains B1 for the single noninferiority-design defect.
Counterpoint. Consider the 13.7% PP exclusion and costs.
Rejudgment record. Source checked — Prespecified PP analysis crossed the -15-point noninferiority margin
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I2 | Decisive evidence is publicly or non-profit funded |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (B).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Noninferior two-year PFS | B | Exceeded the -15-point margin. |
| Superiority over open surgery | ? | Not established. |
Cross-check — AI research and Codex final gate
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Study 1 | Open-label multicenter randomized phase 3 noninferiority trial | 302 | US National Cancer Institute | Two-year progression-free survival | 72.3% vs 71.6%; difference 0.7 points (95% CI -9.6 to 10.9); margin -15 points | Direct cancer-outcome noninferiority RCT |
Receipt — 1 References
All 1 cited sources were verified for existence at the original page (as of 2026-08-26).
Final verification and publication gate: Codex · Verification cutoff: 2026-08-26 · Corrections: none
Cite this verdict
[Chamgap] Benefit of Robot-Assisted Radical Cystectomy for Noninferior 2-Year Progression-Free Survival in Bladder Cancer — Evidence Grade B·76. 1 cited sources checked. Source: https://chamgap.com/en/verdicts/mens/robot-assisted-radical-cystectomy-noninferior-pfs/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
What this document does and does not do
Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.