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. 2017 May 29;8(37):61404-61414.
doi: 10.18632/oncotarget.18248. eCollection 2017 Sep 22.

Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer

Itsuto Hamano  1 , Shingo Hatakeyama  1 , Hiromichi Iwamurau  1 , Naoki Fujita  1 , Ken Fukushi  1 , Takuma Narita  1 , Kazuhisa Hagiwara  1 , Ayumu Kusaka  1 , Shogo Hosogoe  1 , Hayato Yamamoto  1 , Yuki Tobisawa  1 , Tohru Yoneyama  2 , Takahiro Yoneyama  1 , Yasuhiro Hashimoto  2 , Takuya Koie  1 , Hiroyuki Ito  3 , Kazuaki Yoshikawa  4 , Toshiaki Kawaguchi  5 , Chikara Ohyama  1
Affiliations

Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer

Itsuto Hamano et al. Oncotarget. .

Abstract

Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy.

Methods: A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram.

Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively).

Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.

Keywords: bladder cancer; chronic kidney disease; radical cystectomy; renal function; survival.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Oncological outcomes
Before the background adjustment, there were statistically significant differences in PFS (A), CSS (B), and OS (C) between the groups. The pre-CKD group had significantly lower 5-year PFS (57% vs. 73%, P = 0.002), 5-year CSS (63% vs. 79%, P < 0.001), and 5-year OS (55% vs. 74%, P < 0.001) compared to the non-CKD group. In multivariate Cox proportional hazards regression analysis, LVI, pN, stage ≥pT3, pre-CKD, and CVD were selected as independent predictors for PFS (D) and CSS (E). Neobladder was selected as a independent factor for PFS. Similarly, pN, LVI, CVD, pre-CKD, stage ≥pT3, and age were selected as independent predictors for OS (F).
Figure 2
Figure 2. Predictive model for five-year progression-free survival
The nomogram including CVD, pre-CKD, neobladder, LVI, stage ≥pT3, and pN for predicting five-year PFS is shown (A). The calculation for 5-year PFS probability in the case of pre-CKD patients who underwent neobladder substitution without CVD, LVI, stage ≥pT3, and pN provided a value of 74%. The nomogram showed significant correlation between estimated and actual OS (c-index = 0.77, P < 0.001, 95% CI: 0.72–0.81) (B).
Figure 3
Figure 3. Predictive model for 5-year overall survival
The nomogram including age, CVD, pre-CKD, LVI, stage ≥pT3, and pN for predicting 5-year OS is shown (A). The calculation for 5-year OS probability in the case of 80-year-old pre-CKD patients without CVD, LVI, stage ≥pT3, and pN provided a value of 61%. The nomogram showed significant correlation between estimated and actual OS (c-index = 0.73; P < 0.001; 95% CI, 0.68–0.77) (B).
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