title: Chronic kidney disease as an important risk factor for tumor recurrences, progression and overall survival in primary non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  To evaluate the impact of chronic kidney disease (CKD) on oncologic outcomes among non-muscle-invasive bladder cancer (NMIBC) patients who underwent transurethral resection of bladder cancer.
  
  
  METHODS
  We followed up the medical data of 158 newly diagnosed NMIBC patients enrolled in this study for more than 4 years. The ten putative risk factors included patient age, gender, white blood cells, neutrophil to lymphocyte ratio, tumor count, size, grade, stage, CKD (estimated glomerular filtration rate, eGFR < 60) and histological differentiation.
  
  
  RESULTS
  Total recurrent bladder and upper urinary tract (UUT) tumors were observed in 51 patients (32 %) and 5 patients (3 %), respectively. Cancer progression to the high pT(≥pT2) stage was found in 9 patients (6 %). Cancer-specific and overall survival rates were 91 % (144/158 patients) and 78 % (123/158 patients), respectively. In univariate analysis, significant predictive determinants were tumor count, size, grade, stage, CKD and squamous differentiation for bladder tumor recurrence; CKD and squamous differentiation for UUT tumor recurrence; and tumor count, grade, stage and CKD for cancer progression. On the other hand, old age (>70 years), high grade, T1 stage, and CKD were poor prognostic factors for overall survival. In multivariate analysis, CKD was an independent risk factor for bladder/UUT tumor recurrences and the overall survival rate.
  
  
  CONCLUSIONS
  NMIBC patients with CKD had worse prognosis and higher tumor recurrence and progression rates than other patients. These patients should be intensively monitored at upper and lower urinary tracts and be aggressively treated for comorbidities of CKD.
authors.affiliation: Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.
authors.forename: Chia-En
authors.initials: CE
authors.lastname: Li
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Chang Gung University, Kaohsiung, Taiwan.
authors.forename: Chia-Shen
authors.initials: CS
authors.lastname: Chien
authors.affiliation: Chang Gung University, Kaohsiung, Taiwan.|Cancer Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yao-Chi
authors.initials: YC
authors.lastname: Chuang
authors.affiliation: Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.
authors.forename: Ye-In
authors.initials: YI
authors.lastname: Chang
authors.affiliation: Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan.
authors.forename: Hsiu-Pei
authors.initials: HP
authors.lastname: Tang
authors.affiliation: Chang Gung University, Kaohsiung, Taiwan. lice@db.cse.nsysu.edu.tw.|Cancer Center, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. lice@db.cse.nsysu.edu.tw.
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000401:mortality / Q000601:surgery
keywords: Chronic kidney disease; Non-muscle-invasive bladder cancer; Progression; Recurrence; Survival; Urothelial carcinoma