Blute Michael L, Kucherov Victor, Rushmer Timothy J, Damodaran Shivashankar, Shi Fangfang, Abel E Jason, Jarrard David F, Richards Kyle A, Messing Edward M, Downs Tracy M
Department of Urology, University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA.
University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA.
BJU Int. 2017 Sep;120(3):387-393. doi: 10.1111/bju.13904. Epub 2017 Jun 23.
To evaluate if moderate chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m ] is associated with high rates of non-muscle-invasive bladder cancer (NMIBC) recurrence or progression.
A multi-institutional database identified patients with serum creatinine values prior to first transurethral resection of bladder tumour (TURBT). The CKD-epidemiology collaboration formula calculated patient eGFR. Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS).
In all, 727 patients were identified with a median (interquartile range [IQR]) patient age of 69.8 (60.1-77.6) years. Data for eGFR were available for 632 patients. During a median (IQR) follow-up of 3.7 (1.5-6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumour stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified an eGFR of <60 mL/min/1.73 m (hazard ratio [HR] 1.5, 95% confidence interval [CI]: 1.2-1.9; P = 0.002) as a predictor of tumour recurrence. The 5-year RFS rate was 46% for patients with an eGFR of ≥60 mL/min/1.73 m and 27% for patients with an eGFR of <60 mL/min/1.73 m (P < 0.001). Multivariable analysis showed that an eGFR of <60 mL/min/1.73 m (HR 3.7, 95% CI: 1.75-7.94; P = 0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR of ≥60 mL/min/1.73 m and 71% for patients with an eGFR of <60 mL/min/1.73 m (P = 0.01).
Moderate CKD at first TURBT is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance.
评估中度慢性肾脏病[CKD；估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²]是否与非肌层浸润性膀胱癌（NMIBC）的高复发率或进展率相关。
一个多机构数据库确定了首次经尿道膀胱肿瘤切除术（TURBT）前血清肌酐值的患者。CKD流行病学协作公式计算患者的eGFR。Cox比例风险模型评估与无复发生存期（RFS）和无进展生存期（PFS） 的相关性。
总共确定了727例患者，患者年龄中位数（四分位间距[IQR]）为69.8（60.1 - 77.6）岁。632例患者有eGFR数据。在中位（IQR）随访3.7（1.5 - 6.5）年期间，400例（55%）患者出现复发，145例（19.9%）患者出现肿瘤分期或分级进展。根据eGFR，183例患者被确定为中度或重度CKD。多变量分析确定eGFR<60 mL/min/1.73 m²（风险比[HR] 1.5，95%置信区间[CI]：1.2 - 1.9；P = 0.002）是肿瘤复发的预测因素。eGFR≥60 mL/min/1.73 m²的患者5年RFS率为46%，eGFR<60 mL/min/1.73 m²的患者为27%（P < 0.001）。多变量分析显示，eGFR<60 mL/min/1.73 m²（HR 3.7，95% CI：1.75 - 7.94；P = 0.001）与进展为肌层浸润性疾病相关。eGFR≥60 mL/min/1.73 m²的患者5年PFS率为83%，eGFR<60 mL/min/1.73 m²的患者为71%（P = 0.01）。
首次TURBT时的中度CKD与RFS和PFS降低相关。肾功能降低的患者应考虑加强监测。
