The association of preoperative reduced glomerular filtration rate with higher staging and histology grades in patients with urinary tract cancers.

PURPOSE

Studies have shown the increased incidence of urinary tract cancers which are associated with a decrease in glomerular filtration rate (GFR). We hypothesized that patients with GFR < 60 ml/min/1.73 m have an increased risk for higher staging and histology grades of cancers and, therefore, the increased risk for cancer recurrence and cancer-related death.

METHODS

Retrospective clinical data and pathology reports were completed for 2116 patients. Patients were divided into two subgroups regarding GFR; the first group with GFR < 60 ml/min/1.73 m and the second group with GFR > 60 ml/min/1.73 m and regarding cancer recurrence. Cancers were also divided by stages (1-4) according to TNM classification. Patients were followed-up during 3 years.

RESULTS

We have found significantly higher number of cancers with higher histology grades and higher staging in group of patients with GFR < 60 ml/min/1.73 m in all urinary tract localizations. GFR was the strongest predictor for higher cancer histology grade and only significant predictor for higher cancer staging. Patients with GFR < 60 ml/min/1.73 m had OR for higher histology grade, higher staging, and cancer recurrence of 10.7, 5.3, and 11.3 compared to patients with GFR > 60 ml/min.

CONCLUSIONS

Higher staging and histology grades in patients with urinary tract cancers are associated with reduced GFR. Reduced GFR in these patients is a risk factor for cancer recurrence and cancer-related survival. Possible involvement of uremic toxins must be taken into account especially when cancers are predominantly located in estrogen sensitive organs. These patients should be intensively monitored and probably be more aggressively treated.