Prediction of renal function after nephroureterectomy in patients with upper tract urothelial carcinoma.
OBJECTIVE
The estimated glomerular filtration rate is significantly decreased after nephroureterectomy. Deteriorating renal function likely affects the eligibility for cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma. The present study was undertaken to identify preoperative factors for the prediction of postoperative renal function and develop a prediction model.


METHODS
Between June 1996 and January 2014, 110 patients who underwent radical nephroureterectomy at our institution were analyzed in this study. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease study equation. Univariate linear regression analyses were performed to investigate the correlation between postoperative estimated glomerular filtration rate and preoperative variables. A stepwise multivariate linear regression analysis was performed to identify independent predictors of postoperative estimated glomerular filtration rate.


RESULTS
Comparison of preoperative and postoperative estimated glomerular filtration rate for each patient showed a median difference of 13.1 ml/min/1.73 m(2). The postoperative estimated glomerular filtration rate was significantly lower than the preoperative estimated glomerular filtration rate (P < 0.001). On univariate analysis, age and preoperative estimated glomerular filtration rate were significantly correlated with postoperative estimated glomerular filtration rate. On multivariate analysis, age, preoperative estimated glomerular filtration rate and the presence of hydronephrosis were independent predictive factors of postoperative estimated glomerular filtration rate. The predicted postoperative estimated glomerular filtration rate, which was calculated using these independent factors, showed a significant correlation with the observed postoperative estimated glomerular filtration rate (correlation coefficient = 0.7533).


CONCLUSIONS
Age, preoperative estimated glomerular filtration rate and the presence of hydronephrosis were independent predictors of postoperative estimated glomerular filtration rate in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. The predicted postoperative estimated glomerular filtration rate based on these factors may be useful for choosing alternative management strategies such as neoadjuvant chemotherapy for patients with upper tract urothelial carcinoma.
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Takeshi
T
Hashimoto
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Yoshio
Y
Ohno
Department of Urology, Tokyo Medical University, Tokyo, Japan njun@tokyo-med.ac.jp.
Jun
J
Nakashima
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Tatsuo
T
Gondo
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Yoshihiro
Y
Nakagami
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Kazunori
K
Namiki
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Yutaka
Y
Horiguchi
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Kunihiko
K
Yoshioka
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Makoto
M
Ohori
Department of Urology, Tokyo Medical University, Tokyo, Japan.
Masaaki
M
Tachibana
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006869:Hydronephrosis / Q000150:complications*; D007680:Kidney Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods
D002945:Cisplatin
age; estimated glomerular filtration rate; hydronephrosis; nephroureterectomy; upper tract urothelial carcinoma