Clinical Research Papers:
Is preoperative chronic kidney disease status associated with oncologic outcomes in upper urinary tract urothelial carcinoma? A multicenter propensity score-matched analysis
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Ho Song Yu1,*, Jun Eul Hwang3,*, Ho Seok Chung1, Yang Hyun Cho1, Myung Soo Kim1, Eu Chang Hwang1, Kyung Jin Oh1, Sun-Ouck Kim1, Seung Il Jung1, Taek Won Kang1, Dong Deuk Kwon1, Kwangsung Park1, Soo Bang Ryu1,2, Sung-Hoon Jung3, Young Hoe Hur4, Joon Hwa Noh5, Myung Ki Kim6, Ill Young Seo7, Chul-Sung Kim8, Sung Gu Kang9, Seok Ho Kang9 and Jun Cheon9
1 Department of Urology, Chonnam National University Medical School, Gwangju, Korea
2 Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
3 Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
4 Department of General Surgery, Chonnam National University Medical School, Gwangju, Korea
5 Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
6 Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
7 Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
8 Department of Urology, Chosun University School of Medicine, Gwangju, Korea
9 Department of Urology, Korea University College of Medicine, Seoul, Korea
* These authors have contributed equally to this work as first co-authors
Eu Chang Hwang, email:
Keywords: renal insufficiency, chronic, carcinoma, transitional cell, prognosis
Received: January 02, 2017 Accepted: March 06, 2017 Published: March 15, 2017
Purpose: The aim of this study was to determine the effect of preoperative chronic kidney disease (CKD) on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU).
Results: The median follow-up period was 31.1 months (interquartile range: 16.2-55.7 months). Among the study patients, 224 patients in the non-CKD group were selected via propensity score matching. The median recurrence-free, cancer-specific, and overall survival were significantly shorter for patients with preoperative CKD than for non-CKD patients (p = 0.001, p = 0.001, and p = 0.001, respectively). According to multivariable Cox regression analysis, preoperative CKD was related to worse recurrence-free (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.15-2.86, p = 0.011), cancer-specific (HR: 2.44, 95% CI: 1.44-4.14, p = 0.001), and overall survival (HR: 1.66, 95% CI: 1.15-2.40, p = 0.007).
Methods: A total of 566 patients who underwent RNU at 6 institutions from 2004 to 2014 were retrospectively reviewed. Of these patients, 342 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 (non-CKD group) and 224 patients had an eGFR <60 ml/min/1.73 m2 (CKD group). To adjust for potential baseline confounders, 224 patients in the non-CKD group were selected by propensity matching. Clinicopathological variables and survival rates were compared between the 2 groups.
Conclusions: Preoperative CKD appears to be an important independent prognostic factor for oncologic outcomes in patients with UTUC.
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