CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma.
BACKGROUND
The aim of this study is to examine chronic kidney disease (CKD) as a risk factor for bladder recurrence and cancer-specific and total mortality in a cohort of patients with upper urinary tract (UUT) urothelial carcinoma (UC) treated by means of nephroureterectomy.


METHODS
Cohort study.


METHODS
150 patients with primary UC of the ureter or renal pelvis treated by means of nephroureterectomy at a single center.


METHODS
Presence and severity of CKD according to preoperative markers of kidney damage, estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease Study equation, and other covariates.


METHODS
Subsequent bladder recurrences, cancer-specific survival, and overall survival.


RESULTS
Of 150 patients, 37 (25%) had no CKD, 71 patients (47%) had CKD stages 1 to 4, and 42 patients (28%) had CKD stage 5. 41 (27%) and 31 patients (21%) reported exposure to herbal medicine or tobacco use, respectively. During a mean follow-up of 4 years, 53 patients (35%) developed bladder recurrence and 27 (18%) died, of whom 14 (9.3%) died of cancer. Overall 5-year bladder recurrence-free and cancer-specific survival rates were 62% and 89%, respectively (n = 150). Risks of bladder recurrence were 2.43 (95% confidence interval, 1.00 to 5.93) and 3.95 (95% confidence interval, 1.59 to 9.80), greater in patients with CKD stages 1 to 4 and CKD stage 5 compared with patients without CKD, respectively. Ureteral involvement of the primary tumor (hazard ratio, 1.97; 95% confidence interval, 1.12 to 3.48) also was associated significantly with an increased rate of bladder recurrence. The risk of death from all causes or UC was not significantly greater in patients with CKD stages 1 to 4 or CKD stage 5 compared with those without CKD. Higher tumor stage (pT2 to 4) was associated significantly with overall death (hazard ratio, 5.15; 95% confidence interval, 1.84 to 14.48).


CONCLUSIONS
A retrospective study in an area of high incidence of both UUT-UC and CKD.


CONCLUSIONS
Advancing CKD stage of patients and positive ureteral involvement of the primary tumor (especially in the lower ureter) are associated with greater risk of subsequent bladder recurrence in patients with UUT-UC treated by means of radical surgery.
Chung
Shiu-Dong
SD
Department of Surgery, Division of Urology, Far Eastern Memorial Hospital, Ban-Ciao, Taiwan.
Huang
Kuo-How
KH
Lai
Ming-Kuen
MK
Huang
Chao-Yuan
CY
Chen
Chung-Hsin
CH
Pu
Yeong-Shiau
YS
Yu
Hong-Jeng
HJ
Chueh
Shih-Chieh
SC
D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009392:Nephrectomy; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000601:surgery*; D014518:Ureterocele; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery