Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Abstract

ObjectiveTo evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy.MethodsA total of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed.ResultsOf the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively).ConclusionsUpper tract urothelial carcinoma 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.…”

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma

“…The NLR was calculated as the neutrophil count divided by the lymphocyte count 13 . Chronic kidney disease (CKD) was defined as a preoperative eGFR of <60 mL/min/1.73 m 2 14 . Anemia was defined according to the World Health Organization classification as a hemoglobin concentration of ≤13 and ≤12 g/dL in men and women, respectively 15 .…”

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.…”