CKD as a Risk Factor for Bladder Recurrence After Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
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.
1Department of Surgery, Division of Urology, Far Eastern Memorial Hospital, Ban-Ciao
2Department of Urology, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan.
Address correspondence to Shih-Chieh Chueh, MD, PhD, Department of Urology, National Taiwan University Hospital, #7 Chung-Shan South Rd, Taipei, Taiwan 100.
ABSTRACT