Preoperative hydronephrosis predicts advanced bladder cancer but is not an independent factor for cancer-specific survival after radical cystectomy.
BACKGROUND
Hydronephrosis and BMI are analyzed together with established factors such as TNM stage and surgical margins in a multivariate modality to investigate their status as independent prognostic factors for bladder cancer-specific survival in patients undergoing radical cystectomy.


METHODS
We studied a prospective cohort of 328 patients who underwent radical cystectomy for bladder cancer at our institution. Statistical analyses were performed using the Kaplan-Meier method, Kendall-tau rank correlation and multivariate Cox proportional hazard model.


RESULTS
Hydronephrosis was positively correlated with advanced tumor stage, positive lymph node involvement and positive surgical margins. Adjusted for all other investigated parameters, BMI and hydronephrosis did not affect cancer-specific survival. In multivariate analysis only non-organ-confined disease (HR: 1.40, 95% CI: 1.04-1.87, p = 0.024), positive lymph node stage (HR 1.71: 95% CI: 1.12-2.61, p = 0.013) and positive surgical margins (HR 3.00, 95% CI: 1.74-5.15, p < 0.001) were prognostic factors.


CONCLUSIONS
Hydronephrosis at the time of radical cystectomy is significantly correlated with the presence of more advanced bladder cancer and positive surgical margins. However, the long-established parameters pT stage, pN stage and surgical margins predominantly influence cancer-specific survival for patients undergoing radical cystectomy irrespective of hydronephrosis and BMI status.
Department of Urology, University of Heidelberg, Heidelberg, Germany. thomas.hoefner@med.uni-heidelberg.de
Thomas
T
Hofner
Axel
A
Haferkamp
Lena
L
Knapp
Sascha
S
Pahernik
Boris
B
Hadaschik
Nenad
N
Djakovic
Nina
N
Wagener
Markus
M
Hohenfellner
D000368:Aged; D015992:Body Mass Index; D015653:Cystectomy; D005260:Female; D006801:Humans; D006869:Hydronephrosis; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*