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

The impact of preoperative renal impairment severity on prognosis in urothelial carcinoma remains unelucidated.

To evaluate the impact of severe preoperative renal insufficiency on oncological outcomes in patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy.

A total of 1066 patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy at six medical centres from February 1995 to November 2017 were retrospectively examined.

Oncological outcomes, stratified using preoperative estimated glomerular filtration rate (eGFR≥60, 45≤eGFR<60, and eGFR<45ml/min/1.73m2), were investigated. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis was performed to evaluate the impact of preoperative eGFR on prognosis.

Of 610 patients with muscle-invasive bladder cancer (MIBC), 80 (13%) had severe renal insufficiency (eGFR<45ml/min/1.73m2). Of 456 patients with upper tract urothelial carcinoma (UTUC), 101 (22%) had severe renal insufficiency. Significant differences were noted in background and prognosis among the patients with preoperative eGFR≥60, 45≤eGFR<60, and eGFR<45ml/min/1.73m2. Findings of IPTW-adjusted Cox regression analysis demonstrated that preoperative eGFR<45ml/min/1.73m2was significantly associated with poor postsurgical recurrence-free, cancer-specific and overall survival rates in patients with either MIBC or UTUC.

Patients with urothelial carcinoma with preoperative eGFR<45ml/min/1.73m2had a significantly lower survival probability than those without.

In this report, we found that preoperative severe renal insufficiency (estimated glomerular filtration rate<45ml/min/1.73m2) had higher risk for relapse and lower survival probability. Close attention is necessary when urothelial carcinoma patients have severe renal insufficiency before radical cystectomy or nephroureterectomy.

European urology focus. 2018 Mar 13 [Epub ahead of print]

Masaki Momota, Shingo Hatakeyama, Noriko Tokui, Tendo Sato, Hayato Yamamoto, Yuki Tobisawa, Tohru Yoneyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Satoshi Narita, Toshiaki Kawaguchi, Chikara Ohyama

Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. Electronic address: ., Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Urology, Odate General Hospital, Odate, Japan., Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.

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