Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
World J Urol. 2018 Feb;36(2):249-256. doi: 10.1007/s00345-017-2141-2. Epub 2017 Nov 28.
To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes after radical cystectomy (RC) for bladder cancer.
We reviewed the medical records of patients with urothelial bladder carcinoma who underwent RC with curative intent at seven hospitals between 1990 and 2013. After excluding patients with a history of upper urinary tract urothelial cancer or neoadjuvant chemotherapy, we analyzed 594 cases for the study. Preoperative estimated glomerular filtration rate (eGFR) was calculated using the three-variable Japanese equation for GFR estimation from serum creatinine level and age. Patients were divided into four groups of different CKD stages based on eGFR values (mL/min/1.73 m), i.e., ≥ 60 (CKD stages G1-2), 45-60 (G3a), 30-45 (G3b), and < 30 (G4-5). Survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses addressed survivals after RC.
Median age of patients was 67 years. Patients were classified into CKD stages: G1-2 (n = 388; 65.3%), G3a (n = 122; 20.5%), G3b (n = 51; 8.6%), and G4-5 (n = 33; 5.6%). During a median follow-up of 4.0 years, 200 and 164 patients showed cancer progression and died of bladder cancer, with the 5-year progression-free survival (PFS) and cancer-specific survival (CSS) of 64.9 and 70.2%, respectively. On multivariate analyses, CKD stages of G3b or greater, advanced pT stage, lymph node metastasis, and positive lymphovascular invasion were independent poor prognostic factors for PFS and CSS.
We demonstrated that the advanced preoperative CKD stage was significantly associated with poor oncological outcomes of the bladder cancer after RC.
评估术前慢性肾脏病（CKD）对根治性膀胱切除术（RC）治疗膀胱癌后肿瘤学结果的影响。
我们回顾了 1990 年至 2013 年期间在 7 家医院接受根治性 RC 治疗的尿路上皮膀胱癌患者的病历。排除上尿路尿路上皮癌或新辅助化疗史的患者后，我们对 594 例患者进行了分析。使用基于血清肌酐水平和年龄的三变量日本 GFR 估计方程计算术前估算肾小球滤过率（eGFR）。根据 eGFR 值（mL/min/1.73 m），将患者分为不同 CKD 阶段的四个组，即≥60（CKD 阶段 G1-2）、45-60（G3a）、30-45（G3b）和<30（G4-5）。使用 Kaplan-Meier 法估计生存情况。单变量和多变量 Cox 比例风险回归分析探讨了 RC 后的生存情况。
患者的中位年龄为 67 岁。患者被分为 CKD 阶段：G1-2（n=388；65.3%）、G3a（n=122；20.5%）、G3b（n=51；8.6%）和 G4-5（n=33；5.6%）。在中位随访 4.0 年期间，200 名和 164 名患者出现癌症进展并死于膀胱癌，其 5 年无进展生存率（PFS）和癌症特异性生存率（CSS）分别为 64.9%和 70.2%。多变量分析显示，G3b 或更高的 CKD 分期、高级 pT 分期、淋巴结转移和阳性脉管侵犯是 PFS 和 CSS 的独立不良预后因素。
我们表明，术前 CKD 分期较晚与 RC 治疗膀胱癌后的肿瘤学结果不良显著相关。
