Hydronephrosis is an independent predictor of poor clinical outcome in patients treated for muscle-invasive transitional cell carcinoma with radical cystectomy.
OBJECTIVE
The purpose of this study was to assess the prognostic significance of hydronephrosis on pathologic and clinical outcomes in muscle-invasive bladder cancer.


METHODS
We performed a retrospective evaluation of a prospectively maintained cystectomy database and identified patients with hydronephrosis on preoperative imaging. Of a total of 306 patients, 57 (19%) had unilateral hydronephrosis and 17 (6%) had bilateral hydronephrosis. We constructed multivariate Cox regression analysis and Kaplan Meier tables to evaluate the association between preoperative hydronephrosis and clinical outcomes.


RESULTS
In patients without hydronephrosis, 41.4% had extravesical disease compared with 56.1% and 64.7% in patients with unilateral or bilateral hydronephrosis, respectively. Mean overall survival (OS) among patients without hydronephrosis, with unilateral hydronephrosis, and with bilateral hydronephrosis was 55.5, 42.1, and 22.2 months, respectively. Five-year OS and disease-specific survival (DSS) was 46%, 35%, and 22% (P = .001) and 68%, 54%, and 35% (P = .002), respectively. Multivariate analysis demonstrated that both unilateral and bilateral hydronephrosis are significant independent risk factors for DSS and OS. Bilateral hydronephrosis was found to have a hazard ratio of 3.87 (95% confidence interval [CI] = 1.71-8.78, P = .001) and 2.75 (95% CI = 1.45-5.18, P = .002) for DSS and OS, respectively. The hazard ratios for unilateral hydronephrosis were 1.7 (95% CI = 1.05-2.87, P = .03) and 1.5 (95% CI = 1.03-2.23, P = .04) for DSS and OS, respectively.


CONCLUSIONS
Preoperative hydronephrosis is associated with a significantly poorer prognosis in patients with muscle-invasive bladder cancer. These patients should be appropriately counseled with regard to overall prognosis and the potential benefit of neoadjuvant chemotherapy.
Canter
Daniel
D
Department of Surgery, Division of Urology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. daniel.canter@uphs.upenn.edu
Guzzo
Thomas J
TJ
Resnick
Matthew J
MJ
Brucker
Benjamin
B
Vira
Manish
M
Chen
Zhen
Z
Tomaszewski
John
J
VanArsdalen
Keith
K
Wein
Alan J
AJ
Malkowicz
S Bruce
SB
D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D006869:Hydronephrosis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery