Renal function is frequently impaired in the patients with upper tract urothelial carcinoma. We aimed to evaluate the impact of renal function and its change after surgery on survival rates in patients with upper tract urothelial carcinoma after nephroureterectomy.
The study cohort comprised 755 patients with upper tract urothelial carcinoma who underwent nephroureterectomy between 1995 and 2016 at nine hospitals in Japan. Estimated glomerular filtration rate was calculated using the three-variable Japanese equation for glomerular filtration rate estimation from serum creatinine level and age. Outcomes were recurrence-free, cancer-specific and overall survivals. Univariate and multivariate Cox proportional hazards regression analyses were used.
Median patients' age was 72 years old. Pre- and post-surgical median estimated glomerular filtration rate were 55.5 and 42.9 ml/min/1.73 m2, respectively. Median estimated glomerular filtration rate decline after surgery, which represents function of the affected side kidney, was 13.1 ml/min/1.73 m2. The 5-year recurrence-free, cancer-specific and overall survivals were 68.3, 79.4 and 74.0%, respectively. Multivariate analysis indicated that lower preoperative estimated glomerular filtration rate and estimated glomerular filtration rate decline were associated with poorer recurrence-free, cancer-specific and overall survivals, but post-operative estimated glomerular filtration rate was not. Estimated glomerular filtration rate decline was more significant poor-prognosticator than preoperative estimated glomerular filtration rate. Proportions of the patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 before surgery were 50.6 and 73.2% in organ-confined disease and locally advanced disease, respectively (P < 0.0001). After surgery, they were 91.6 and 89.8%, respectively (P = 0.3896).
Lower preoperative renal function, especially of the affected side kidney, was significantly associated with poor prognosis after nephroureterectomy for upper tract urothelial carcinoma. Many patients with locally advanced disease have reduced renal function at diagnosis and even more after surgery.
Japanese journal of clinical oncology. 2021 May 28 [Epub ahead of print]
Yukio Yamada, Tohru Nakagawa, Jimpei Miyakawa, Taketo Kawai, Mariko Tabata, Tomoyuki Kaneko, Satoru Taguchi, Akihiro Naito, Masahiro Hikatsu, Yusuke Sato, Taro Murata, Akihiko Matsumoto, Hideyo Miyazaki, Motofumi Suzuki, Yutaka Enomoto, Hiroaki Nishimatsu, Yasushi Kondo, Takumi Takeuchi, Yoshinori Tanaka, Haruki Kume
Department of Urology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan., Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan., Department of Urology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan., Department of Urology, Tokyo Teishin Hospital, Chiyoda, Tokyo, Japan., Department of Urology, Yaizu City Hospital, Yaizu, Shizuoka, Japan., Department of Urology, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan., Department of Urology, Mitsui Memorial Hospital, Chiyoda, Tokyo, Japan., Department of Urology, The Fraternity Memorial Hospital, Sumida, Tokyo, Japan., Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Sumida, Tokyo, Japan., Department of Urology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kawasaki Kanagawa, Japan.