title: Poor Preoperative Glycemic Control Is Associated with Dismal Prognosis after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).
  
  
  METHODS
  A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival.
  
  
  RESULTS
  The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001).
  
  
  CONCLUSIONS
  Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.
authors.affiliation: Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sung Gu
authors.initials: SG
authors.lastname: Kang
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Eu Chang
authors.initials: EC
authors.lastname: Hwang
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Jung
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ho Song
authors.initials: HS
authors.lastname: Yu
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ho Seok
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Taek Won
authors.initials: TW
authors.lastname: Kang
authors.affiliation: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.affiliation: Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jun Eul
authors.initials: JE
authors.lastname: Hwang
authors.affiliation: Department of Urology, Kwangju Christian Hospital, Gwangju, Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Urology, Kwangju Christian Hospital, Gwangju, Korea.
authors.forename: Joon Hwa
authors.initials: JH
authors.lastname: Noh
authors.affiliation: Department of Urology, Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: You
authors.affiliation: Department of Urology, Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: Myung Ki
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Oh
authors.affiliation: Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Ill Young
authors.initials: IY
authors.lastname: Seo
authors.affiliation: Department of Urology, Chosun University School of Medicine, Gwangju, Korea.
authors.forename: Seung
authors.initials: S
authors.lastname: Baik
authors.affiliation: Department of Urology, Chosun University School of Medicine, Gwangju, Korea.
authors.forename: Chul-Sung
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Urology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000378:metabolism / Q000473:pathology*; D048909:Diabetes Complications / Q000378:metabolism / Q000473:pathology*; D003920:Diabetes Mellitus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology; D000074682:Nephroureterectomy / Q000009:adverse effects; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000503:physiopathology* / Q000601:surgery
keywords: Diabetes mellitus; Prognosis; Transitional cell carcinoma