Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Eur Urol Focus. 2019 Nov;5(6):1066-1073. doi: 10.1016/j.euf.2018.03.003. Epub 2018 Mar 13.
The impact of preoperative renal impairment severity on prognosis in urothelial carcinoma remains unelucidated.
To evaluate the impact of severe preoperative renal insufficiency on oncological outcomes in patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy.
DESIGN, SETTING, AND PARTICIPANTS: A total of 1066 patients with urothelial carcinoma who underwent radical cystectomy or nephroureterectomy at six medical centres from February 1995 to November 2017 were retrospectively examined.
Oncological outcomes, stratified using preoperative estimated glomerular filtration rate (eGFR≥60, 45≤eGFR<60, and eGFR<45ml/min/1.73m), were investigated. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis was performed to evaluate the impact of preoperative eGFR on prognosis.
Of 610 patients with muscle-invasive bladder cancer (MIBC), 80 (13%) had severe renal insufficiency (eGFR<45ml/min/1.73m). Of 456 patients with upper tract urothelial carcinoma (UTUC), 101 (22%) had severe renal insufficiency. Significant differences were noted in background and prognosis among the patients with preoperative eGFR≥60, 45≤eGFR<60, and eGFR<45ml/min/1.73m. Findings of IPTW-adjusted Cox regression analysis demonstrated that preoperative eGFR<45ml/min/1.73m was significantly associated with poor postsurgical recurrence-free, cancer-specific and overall survival rates in patients with either MIBC or UTUC.
Patients with urothelial carcinoma with preoperative eGFR<45ml/min/1.73m had a significantly lower survival probability than those without.
In this report, we found that preoperative severe renal insufficiency (estimated glomerular filtration rate<45ml/min/1.73m) had higher risk for relapse and lower survival probability. Close attention is necessary when urothelial carcinoma patients have severe renal insufficiency before radical cystectomy or nephroureterectomy.
术前肾功能损害严重程度对尿路上皮癌患者预后的影响仍不清楚。
评估术前严重肾功能不全对接受根治性膀胱切除术或肾输尿管切除术的尿路上皮癌患者的肿瘤学结局的影响。
设计、地点和参与者：回顾性分析了 1995 年 2 月至 2017 年 11 月 6 家医疗中心接受根治性膀胱切除术或肾输尿管切除术的 1066 例尿路上皮癌患者的资料。
根据术前估算肾小球滤过率（eGFR≥60、45≤eGFR<60 和 eGFR<45ml/min/1.73m）分层，评估肿瘤学结局。采用逆概率治疗加权（IPTW）调整的 Cox 比例风险回归分析评估术前 eGFR 对预后的影响。
在 610 例肌层浸润性膀胱癌（MIBC）患者中，80 例（13%）有严重肾功能不全（eGFR<45ml/min/1.73m）。在 456 例上尿路上皮癌（UTUC）患者中，101 例（22%）有严重肾功能不全。术前 eGFR≥60、45≤eGFR<60 和 eGFR<45ml/min/1.73m 的患者在背景和预后方面存在显著差异。IPTW 调整的 Cox 回归分析结果表明，术前 eGFR<45ml/min/1.73m 与 MIBC 或 UTUC 患者手术后无复发生存、癌症特异性生存和总生存的低概率显著相关。
术前 eGFR<45ml/min/1.73m 的尿路上皮癌患者的生存概率明显低于无 eGFR<45ml/min/1.73m 的患者。
在本报告中，我们发现术前严重肾功能不全（估算肾小球滤过率<45ml/min/1.73m）与复发风险增加和生存概率降低相关。在接受根治性膀胱切除术或肾输尿管切除术之前，尿路上皮癌患者如果有严重的肾功能不全，需要密切关注。
