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Research Papers:

Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Hirotake Kodama, Shingo Hatakeyama _, Naoki Fujita, Hiromichi Iwamura, Go Anan, Ken Fukushi, Takuma Narita, Toshikazu Tanaka, Yuka Kubota, Hirotaka Horiguchi, Masaki Momota, Koichi Kido, Teppei Matsumoto, Osamu Soma, Itsuto Hamano, Hayato Yamamoto, Yuki Tobisawa, Tohru Yoneyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Hiroyuki Ito, Kazuaki Yoshikawa, Atsushi Sasaki, Toshiaki Kawaguchi, Makoto Sato and Chikara Ohyama

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Oncotarget. 2017; 8:83183-83194. https://doi.org/10.18632/oncotarget.20554

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Abstract

Hirotake Kodama1, Shingo Hatakeyama1, Naoki Fujita1, Hiromichi Iwamura1,2, Go Anan1,2, Ken Fukushi1, Takuma Narita1, Toshikazu Tanaka1, Yuka Kubota1, Hirotaka Horiguchi1, Masaki Momota1, Koichi Kido1, Teppei Matsumoto1, Osamu Soma1, Itsuto Hamano1, Hayato Yamamoto1, Yuki Tobisawa1, Tohru Yoneyama3, Takahiro Yoneyama1, Yasuhiro Hashimoto3, Takuya Koie1, Hiroyuki Ito4, Kazuaki Yoshikawa5, Atsushi Sasaki6, Toshiaki Kawaguchi7, Makoto Sato2 and Chikara Ohyama1,3

1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

2Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

3Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

4Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan

5Department of Urology, Mutsu General Hospital, Mutsu, Japan

6Department of Urology, Tsugaru General Hospital, Goshogawara, Japan

7Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan

Correspondence to:

Shingo Hatakeyama, email: [email protected]

Keywords: upper urinary tract urothelial carcinoma, radical nephroureterectomy, chronic kidney disease, renal function, oncological outcome

Received: July 19, 2017     Accepted: July 28, 2017     Published: August 24, 2017

ABSTRACT

Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy.

Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed.

Results: Of the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively).

Conclusions: Upper tract urothelial carcinoma patients with preoperative CKD had a significantly lower survival probability than those without CKD.


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