Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer

Abstract

ObjectiveTo evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy.MethodsA total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogramResultsOf the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively).ConclusionsMuscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.

The Impact of Preoperative Severe Renal Insufficiency on Poor Postsurgical Oncological Prognosis in Patients with Urothelial Carcinoma

“…Our results demonstrated that the prevalence of preoperative eGFR < 45 ml/min/1. As the prevalence of older age is higher among patients with urothelial carcinoma, studies report a recent increase in interest in the impact of preoperative renal insufficiency on poor prognosis [13][14][15]24,25]. Several studies have indicated an association between chronic kidney disease (CKD) and oncological outcomes associated with the effects of chronic inflammation, oxidative stress, metabolic disorder, uraemiaassociated immune deficiency, and frailty [26][27][28].…”

“…Established predictors of prognosis include older age (>70-75 yr), tumour stage, tumour location, lymphovascular invasion (LVI), lymph node involvement [8], and mode of recurrence [9,10]. Recent evidence has suggested that preoperative renal insufficiency indicates poor prognosis in patients with MIBC and UTUC [11][12][13][14][15]. However, the impact of preoperative renal impairment severity on prognosis in urothelial carcinoma remains unelucidated.…”

Risk-stratified surveillance protocol improves cost-effectiveness after radical nephroureterectomy in patients with upper tract urothelial carcinoma

“…Previous studies have suggested that kidney and urinary tract cancers are high risk for renal dysfunction due to tumor location (obstruction, and/or reduction of nephron mass) [16][17][18]. Our previous studies suggested that patients with stage 3 CKD had significantly higher risk for recurrence and cancer death compared to those without CKD [19][20][21]. In addition, UTUC has great potential for renal dysfunction during disease progression.…”

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer

“…Not only pathological outcomes, but also preoperative variables including CVD and CKD had a significant impact on recurrence after RC. Recent studies suggested the impact of CKD on prognosis in MIBC [ 12 ] and upper urinary tract urothelial cancer [ 13 ]. Patients with renal impairment are at risk of CVD [ 14 ], but the reason for the strong association between CKD and poor recurrence-free survival is not clear.…”