Clinical Research Papers:
Risk of acute myocardial infarction in upper tract urothelial carcinoma patients receiving radical nephroureterectomy: a population-based cohort study
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Shih-Yi Lin1,2,3, Cheng-Li Lin4,5, Chao-Hsiang Chang6, His-Chin Wu6, I-Kuan Wang1,2,3, Che-Yi Chou1,2,3 and Ji-An Liang1,7
1Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
2Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
3Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
4Managment Office for Health Data, China Medical University Hospital, Taichung, Taiwan
5College of Medicine, China Medical University, Taichung, Taiwan
6Department of Urology, China Medical University Hospital, Taichung, Taiwan
7Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
Ji-An Liang, email: [email protected]
Keywords: upper tract urothelial carcinoma, acute myocardial infarction, mortality, radical nephroureterectomy, multivariable Cox proportional hazard regression analysis
Received: April 07, 2017 Accepted: May 29, 2017 Published: June 15, 2017
Background: The outcomes of upper tract urothelial carcinoma (UTUC) receiving radical nephroureterectomy were usually limited to small sample size, case-control studies, and often focused on cancer progression. Risk of acute myocardial infarction (AMI) in these patients was never investigated.
Results: The overall incidences of AMI were 3.39, 1.44, and 1.70 per 10,000 person-years in the radical nephroureterectomy, nonnephroureterectomy, and non-UTUC cohorts, respectively. Multivariable Cox proportional hazard regression analysis revealed a significantly higher AMI risk in the radical nephroureterectomy cohort [adjusted HR (aHR) = 1.83, 95% confidence interval (CI) = 1.08–3.11], compared with non-UTUC cohorts. The risk of mortality were the highest in patients with UTUC who had undergone radical nephroureterectomy [adjusted HR (aHR) = 5.37, 95% confidence interval (CI) = 4.80–6.02].
Materials and Methods: From the Taiwan National Health Insurance claims data, 1,359 patients with UTUC who had undergone radical nephroureterectomy and 3,154 patients with UTUC who had undergone nephron sparing surgery and were newly diagnosed between 2000 and 2010 were identified. For each patient, 4 individuals without UTUC were randomly selected and frequency matched by age, sex, and diagnosis year.
Conclusions: Patients with UTUC who have undergone radical nephroureterectomy are at a higher risk of developing AMI, compared with those receiving nephron sparing surgery.
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