The significance of preoperative estimated glomerular filtration rate on survival outcomes in patients who underwent radical cystectomy and non-continent urinary diversion

Abstract

Purpose: To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD). Materials and Methods: A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR) <60mL/ min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients' characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups. Results: The mean age was 64.5±8.7 (range: 32-83) years and the median followup was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2. Conclusions: Overall mortality was higher and overall survival was lower in patients with preoperative eGFR <60mL/s. More patients had preoperative hydronephrosis with eGFR< 60mL/s.

Reduced Preoperative Glomerular Filtration Rate Is Associated With Adverse Postoperative Oncological Prognosis in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Retrospective Cohort Study

“…In a retrospective population-based cohort study of more than 1 million individuals between 2000 and 2008, the authors reported a 48% increased risk of uroepithelial carcinoma in patients with eGFR <30 mL/min/1.73 m 2 compared with the eGFR of 60–89 mL/min/1.73 m 2 ( 21 ). Even in patients with mildly impaired renal function, changes in eGFR can lead to the development of more aggressive cancers, resulting in high rates of recurrence and mortality ( 15 , 22 , 23 ). The results of this study highlight the importance of severe renal insufficiency in oncological outcomes, revealing that OS, CSS, and PFS exhibit a decrease in preoperative eGFR <60 mL/min/1.73 m 2 and a significant deterioration in survival at eGFR ≤ 45 mL/min/1.73 m 2 .…”