The aggressiveness of urinary tract urothelial carcinoma increases with the severity of chronic kidney disease.
OBJECTIVE
To assess, in a retrospective cohort, urinary tract urothelial carcinoma (UT-UC) in patients with various stages of chronic kidney disease (CKD) and their clinicopathological features, as patients with end-stage renal disease (ESRD) have a higher incidence of UT-UC, but the relationship between early stages of CKD and characteristics of UT-UC are less well known.


METHODS
The study included 267 patients with pathologically confirmed UT-UC from January 1994 to December 2006; all had a physical examination (blood pressure), and measurements of laboratory data (serum creatinine, serum haemoglobin) and pathological data. The glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation. Patients were divided into three groups by individual GFR (mL/min), i.e. >60 (no/mild CKD), 30-60 (CKD stage 3) and <30 (CKD stage 4/5).


RESULTS
The CKD stages included 81 (30.3%) patients with none/mild CKD, 121 (45.3%) with CKD stage 3 and 65 (24.3%) with CKD stage 4/5. There was a significant and parallel increase in the frequency of UT-UC as CKD severity increased from none/mild CKD to stage 3 (11% vs 55%), and from CKD stage 3 to 4/5 (55% vs 71%; P < 0.05). Pathologically, the frequency of high-grade and high T stage UT-UC in patients with CKD stage 3 (90% and 35%, respectively) and CKD stage 4/5 (91% and 29%, respectively) were significantly greater than in the group with none/mild CKD (P < 0.001). Advanced age and more distant metastasis were independent risk factors for patient survival.


CONCLUSIONS
The aggressiveness of UT-UC increased with the severity of CKD, and this might have important clinical consequences.
Hung
Peir-Haur
PH
Department of Internal Medicine, Chia-yi Christian Hospital, Chia-yi, Taiwan.
Shen
Cheng-Huang
CH
Chiu
Yen-Ling
YL
Jong
Ing-Ching
IC
Chiang
Pei-Chun
PC
Lin
Chang-Te
CT
Hung
Kuan-Yu
KY
Tsai
Tun-Jun
TJ
D000368:Aged; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014571:Urologic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology*; D019459:Urothelium / Q000473:pathology