The relationship between preoperative stage 3B chronic kidney disease and post-surgical oncological outcomes in patients with urothelial carcinoma

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Surgical Oncology
Cancer Treatment in Patients with Comorbidities
Presenter Shingo Hatakeyama
Citation Annals of Oncology (2018) 29 (suppl_9): ix74-ix78. 10.1093/annonc/mdy435
Authors S. Hatakeyama, H. Yamamoto, A. Imai, T. Yoneyama, Y. Hashimoto, T. Koie, C. Ohyama
  • Urology, Hirosaki Univ. School of Med., 036-8560 - Hirosaki/JP

Abstract

Background

Urothelial carcinomas are heterogeneous group of cancers, including urinary bladder carcinoma and upper urinary tract urothelial carcinoma (UTUC). Recent evidence has suggested that preoperative renal insufficiency indicates poor prognosis in patients with MIBC and UTUC. However, the impact of preoperative stage 3 chronic kidney disease (CKD) on prognosis remains unelucidated. We aimed to evaluate the impact of severe preoperative renal insufficiency on oncological outcomes in patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy.

Methods

A total of 1066 patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy at six medical centres during the period 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 <45 mL/min/1.73 m2), were investigated. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazards regression analysis was performed to evaluate the impact of preoperative eGFR on prognosis.

Results

Of 610 patients with muscle-invasive bladder cancer (MIBC), 80 (13%) had severe renal insufficiency (eGFR<45 mL/min/1.73 m2). Of 456 patients with 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<45 mL/min/1.73 m2. Findings of IPTW-adjusted Cox regression analysis demonstrated that preoperative eGFR<45 mL/min/1.73 m2 was significantly associated with poor post-surgical recurrence-free, cancer-specific and overall survival rates in patients with either MIBC or UTUC.

Conclusions

Patients with urothelial carcinoma with preoperative eGFR<45 mL/min/1.73 m2 (stage 3B CKD) had a significantly lower survival probability than those without.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Shingo Hatakeyama.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.