American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 743-753, November 2007

CKD as a Risk Factor for Bladder Recurrence After Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

  • Shiu-Dong Chung, MD

      Affiliations

    • Department of Surgery, Division of Urology, Far Eastern Memorial Hospital, Ban-Ciao
    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Kuo-How Huang, MD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Ming-Kuen Lai, MD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Chao-Yuan Huang, MD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Chung-Hsin Chen, MD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Yeong-Shiau Pu, MD, PhD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Hong-Jeng Yu, MD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • ,
  • Shih-Chieh Chueh, MD, PhD

      Affiliations

    • Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
    • Corresponding Author InformationAddress correspondence to Shih-Chieh Chueh, MD, PhD, Department of Urology, National Taiwan University Hospital, #7 Chung-Shan South Rd, Taipei, Taiwan 100.

Received 24 March 2007; accepted 7 August 2007. published online 08 October 2007.

Background

The aim of this study is to examine chronic kidney disease (CKD) as a risk factor for bladder recurrence and cancer-specific and total mortality in a cohort of patients with upper urinary tract (UUT) urothelial carcinoma (UC) treated by means of nephroureterectomy.

Study Design

Cohort study.

Settings & Participants

150 patients with primary UC of the ureter or renal pelvis treated by means of nephroureterectomy at a single center.

Predictor

Presence and severity of CKD according to preoperative markers of kidney damage, estimated glomerular filtration rate calculated using the Modification of Diet in Renal Disease Study equation, and other covariates.

Outcomes & Measurements

Subsequent bladder recurrences, cancer-specific survival, and overall survival.

Results

Of 150 patients, 37 (25%) had no CKD, 71 patients (47%) had CKD stages 1 to 4, and 42 patients (28%) had CKD stage 5. 41 (27%) and 31 patients (21%) reported exposure to herbal medicine or tobacco use, respectively. During a mean follow-up of 4 years, 53 patients (35%) developed bladder recurrence and 27 (18%) died, of whom 14 (9.3%) died of cancer. Overall 5-year bladder recurrence–free and cancer-specific survival rates were 62% and 89%, respectively (n = 150). Risks of bladder recurrence were 2.43 (95% confidence interval, 1.00 to 5.93) and 3.95 (95% confidence interval, 1.59 to 9.80), greater in patients with CKD stages 1 to 4 and CKD stage 5 compared with patients without CKD, respectively. Ureteral involvement of the primary tumor (hazard ratio, 1.97; 95% confidence interval, 1.12 to 3.48) also was associated significantly with an increased rate of bladder recurrence. The risk of death from all causes or UC was not significantly greater in patients with CKD stages 1 to 4 or CKD stage 5 compared with those without CKD. Higher tumor stage (pT2 to 4) was associated significantly with overall death (hazard ratio, 5.15; 95% confidence interval, 1.84 to 14.48).

Limitations

A retrospective study in an area of high incidence of both UUT-UC and CKD.

Conclusions

Advancing CKD stage of patients and positive ureteral involvement of the primary tumor (especially in the lower ureter) are associated with greater risk of subsequent bladder recurrence in patients with UUT-UC treated by means of radical surgery.

Index Words: Urothelial carcinoma, chronic kidney disease (CKD), upper urinary tract, bladder recurrence, nephroureterectomy

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 30.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Originally published online as doi:10.1053/j.ajkd.2007.08.007 on October 8, 2007.

PII: S0272-6386(07)01143-2

doi:10.1053/j.ajkd.2007.08.007

American Journal of Kidney Diseases
Volume 50, Issue 5 , Pages 743-753, November 2007

Article Tools

* Image Usage & Resolution