title: Diabetes mellitus with poor glycemic control increases bladder cancer recurrence risk in patients with upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  The association of diabetes mellitus and bladder cancer recurrence following radical nephroureterectomies (RNUs) in patients with upper urinary tract urothelial carcinoma (UTUC) was investigated.
  
  
  METHODS
  Between January 1996 and March 2009, 538 patients with UTUC who received RNU and had no previous bladder cancer histories were enrolled. The clinicopathological characteristics were obtained and used for the analysis of metachronous bladder recurrence by using Cox proportional hazard model.
  
  
  RESULTS
  The diabetic patients (N = 104, 19.3%) were elderly (72 vs 67 years, p < 0.001) and had more hypertension (56.7 vs 34.5%, p < 0.001) as compared with non-diabetic patients. There was no significant difference in the rest of clinicopathological characteristics between patient groups. During the median follow-up duration of 51 months, bladder recurrences were discovered in 47.1 and 33.1% of diabetic and non-diabetic patients with UTUC, respectively. Poorly controlled diabetic patients (HbA1c  ≥ 7.0%) exhibited a shorter duration of bladder cancer recurrence-free survival as compared with those with good glycemic controlled diabetes mellitus and without diabetes mellitus (log-rank test, p < 0.001 and <0.001, respectively). In the multivariate analysis, male gender [hazard ratio (HR) = 1.67, p = 0.017], ureteral tumour (HR = 1.61, p = 0.020), end-stage renal disease (HR = 2.09, p = 0.030) and diabetes mellitus with poor glycemic control (HR = 2.10, p < 0.018) independently predicted bladder recurrence after RNU.
  
  
  CONCLUSIONS
  Diabetes mellitus with poor glycemic control (HbA1c  ≥ 7.0%) increases the risk of subsequent bladder cancer recurrence. These results underscore the need for intensive glycemic control and close follow-up for diabetic patients.
authors.affiliation: Department of Urology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Tai
authors.forename: Chung-Hsin
authors.initials: CH
authors.lastname: Chen
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.forename: Huai-Chin
authors.initials: HC
authors.lastname: Tai
authors.forename: Sho-Mon
authors.initials: SM
authors.lastname: Wang
authors.forename: Yeong-Shiau
authors.initials: YS
authors.lastname: Pu
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: HbA1c; bladder cancer; diabetes mellitus; upper urinary tract urothelial carcinoma