title: Multi-institutional analysis of renal function outcomes following radical nephroureterectomy and partial ureterectomy for upper tract urothelial carcinoma.
abstract: OBJECTIVE
  To compare renal function outcomes in patients undergoing radical nephroureterectomy (RNU) or partial (distal) ureterectomy (PU) for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Clinicopathologic data of patients undergoing RNU or PU for UTUC from 1998 to 2012 were compiled. Glomerular filtration rate was calculated preoperatively and postoperatively using the Modification of Diet in Renal Disease equation. We defined "event" as new-onset stage III chronic kidney disease (CKD) or worsening of CKD stage with preexisting CKD. Event-free survival was assessed with Kaplan-Meier methods. Cox regression analyses were performed to identify predictors of events.
  
  
  RESULTS
  In total, 193 patients underwent RNU (n = 143) or PU (n = 50) over a median follow-up of 25.9 months. Overall, 15% of patients died of UTUC. High tumor grade (85.9% vs. 66.0%, P = 0.003) and locally advanced stage (>pT2, 37.8% vs. 18.0%, P = 0.014) were significantly more frequent in the RNU cohort. Stage III or higher CKD was present in 61% of RNU patients vs. 48% of PU patients (P = 0.135) at baseline. Although total event rate was higher in the PU cohort (66% vs. 43.4%, P = 0.008), event rates within the first 3 months of surgery were similar between the groups (P = 0.572). Adjuvant chemotherapy was the only predictor of events on Cox regression.
  
  
  CONCLUSIONS
  Rates of new-onset CKD or worsening of CKD stage were similar in patients treated with RNU and PU. Adjuvant chemotherapy may have a more significant effect on renal outcomes than surgical approach, warranting further investigation. Consideration should be given to preoperative chemotherapy, as adjuvant chemotherapy is limited by decreased renal function following surgery.
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Nirmish
authors: N
authors: Singla
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Bishoy A
authors: BA
authors: Gayed
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Aditya
authors: A
authors: Bagrodia
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Laura-Maria
authors: LM
authors: Krabbe
authors: Department of Urology, University of California San Diego, San Diego, CA.
authors: Kerrin L
authors: KL
authors: Palazzi
authors: Department of Urology, University of California San Diego, San Diego, CA.
authors: Hossein
authors: H
authors: Mirheydar
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Brian
authors: B
authors: Harrow
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Corbin
authors: C
authors: Jacobs
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Ramy
authors: R
authors: Youssef
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Oussama
authors: O
authors: Darwish
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Arthur
authors: A
authors: Sagalowsky
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Yair
authors: Y
authors: Lotan
authors: Department of Urology, University of California San Diego, San Diego, CA.
authors: Ithaar
authors: I
authors: Derweesh
authors: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: vitaly.margulis@utsouthwestern.edu.
authors: Vitaly
authors: V
authors: Margulis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*
keywords: Partial ureterectomy; Radical nephroureterectomy; Renal function; Upper tract urothelial carcinoma