Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer
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Itsuto Hamano1, Shingo Hatakeyama1, Hiromichi Iwamura1, Naoki Fujita1, Ken Fukushi1, Takuma Narita1, Kazuhisa Hagiwara1, Ayumu Kusaka1, Shogo Hosogoe1, Hayato Yamamoto1, Yuki Tobisawa1, Tohru Yoneyama2, Takahiro Yoneyama1, Yasuhiro Hashimoto2, Takuya Koie1, Hiroyuki Ito3, Kazuaki Yoshikawa4, Toshiaki Kawaguchi5 and Chikara Ohyama1,2
1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
2Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
3Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
4Department of Urology, Mutsu General Hospital, Mutsu, Japan
5Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
Shingo Hatakeyama, email: [email protected]
Keywords: bladder cancer, radical cystectomy, survival, chronic kidney disease, renal function
Received: March 17, 2017 Accepted: April 17, 2017 Published: May 29, 2017
Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy.
Methods: A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram.
Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively).
Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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