Hamano Itsuto, Hatakeyama Shingo, Iwamurau Hiromichi, Fujita Naoki, Fukushi Ken, Narita Takuma, Hagiwara Kazuhisa, Kusaka Ayumu, Hosogoe Shogo, Yamamoto Hayato, Tobisawa Yuki, Yoneyama Tohru, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Ito Hiroyuki, Yoshikawa Kazuaki, Kawaguchi Toshiaki, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Oncotarget. 2017 May 29;8(37):61404-61414. doi: 10.18632/oncotarget.18248. eCollection 2017 Sep 22.
To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy.
A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram.
Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (-index = 0.73 and 0.77, respectively).
Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.
评估术前慢性肾脏病（CKD）对接受根治性膀胱切除术的肌层浸润性膀胱癌患者肿瘤学结局的影响。
回顾性研究了1995年1月至2017年2月期间在四个医疗中心接受根治性膀胱切除术的581例患者。我们调查了肿瘤学结局，包括按术前CKD状态（术前CKD与非CKD）分层的无进展生存期、癌症特异性生存期和总生存期（分别为PFS、CSS和OS）。我们使用治疗权重逆概率（IPTW）进行Cox比例风险回归分析，以评估术前CKD对预后的影响，并制定了基于预后因素的风险分层列线图。
在581例患者中，215例（37%）在根治性膀胱切除术之前被诊断为CKD。在进行背景调整之前，与非CKD组相比，术前CKD组根治性膀胱切除术后的PFS、CSS和OS显著更低。经背景调整的IPTW分析显示，术前CKD与根治性膀胱切除术后不良的PFS、CSS和OS显著相关。预测5年PFS和OS概率的列线图与实际的PFS和OS显示出显著相关性（-指数分别为0.73和0.77）。
术前患有CKD的肌层浸润性膀胱癌患者的生存概率显著低于未患CKD的患者。
