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. 2017 Aug 24;8(47):83183-83194.
doi: 10.18632/oncotarget.20554. eCollection 2017 Oct 10.

Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Hirotake Kodama  1 , Shingo Hatakeyama  1 , Naoki Fujita  1 , Hiromichi Iwamura  1   2 , Go Anan  1   2 , Ken Fukushi  1 , Takuma Narita  1 , Toshikazu Tanaka  1 , Yuka Kubota  1 , Hirotaka Horiguchi  1 , Masaki Momota  1 , Koichi Kido  1 , Teppei Matsumoto  1 , Osamu Soma  1 , Itsuto Hamano  1 , Hayato Yamamoto  1 , Yuki Tobisawa  1 , Tohru Yoneyama  3 , Takahiro Yoneyama  1 , Yasuhiro Hashimoto  3 , Takuya Koie  1 , Hiroyuki Ito  4 , Kazuaki Yoshikawa  5 , Atsushi Sasaki  6 , Toshiaki Kawaguchi  7 , Makoto Sato  2 , Chikara Ohyama  1   3
Affiliations

Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Hirotake Kodama et al. Oncotarget. .

Abstract

Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy.

Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed.

Results: Of the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively).

Conclusions: Upper tract urothelial carcinoma patients with preoperative CKD had a significantly lower survival probability than those without CKD.

Keywords: chronic kidney disease; oncological outcome; radical nephroureterectomy; renal function; upper urinary tract urothelial carcinoma.

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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, statistically significant differences were observed in intravesical recurrence-free (A), visceral recurrence-free (B), cancer-specific (C), and overall survival (D) between the groups.
Figure 2
Figure 2. Multivariate Cox regression models for intravesical recurrence-free, visceral recurrence-free, and cancer-specific survival
Previous/synchronous bladder cancer and preoperative CKD were identified as independent factors for intravesical recurrence-free survival (A). Surgical margin, lymphovascular invasion (LVI), pathological T3 or higher, preoperative CKD, and ureter or multiple tumors were identified as independent factors for visceral recurrence-free survival (B). Similarly, surgical margin, LVI, pathological T3 or higher, and preoperative CKD were identified as independent factors for cancer-specific survival (C).
Figure 3
Figure 3. Predictive model for 3-year intravesical recurrence-free survival
The nomogram including age, sex, preoperative CKD, hydronephrosis, tumor location, previous/synchronous bladder cancer (BC) for predicting 3-year intravesical recurrence-free survival is shown. The calculation for 3-year intravesical recurrence-free survival probability in the case of 70-year-old male patients who underwent radical nephroureterectomy with bladder cuff excision with preoperative CKD, hydronephrosis, ureter tumor, and positive history of previous BC provided a value of 47%. The nomogram demonstrated a significant correlation between estimated and actual intravesical recurrence-free survival (c-index = 0.63, P < 0.001, 95% CI: 0.57–0.69).
Figure 4
Figure 4. Predictive model for 5-year visceral recurrence-free survival
The nomogram including age, sex, preoperative CKD, hydronephrosis, tumor location, pT, lymphovascular invasion (LVI), surgical margin, cN+ or pN+ for predicting 5-year visceral recurrence-free survival is shown. The calculation for 5-year visceral recurrence-free survival probability in the case of 70-year-old male patients who underwent radical nephroureterectomy with bladder cuff excision with preoperative CKD, hydronephrosis, ureter tumor, pT3, LVI, negative surgical margin, and negative in cN or pN provided a value of 26%. The nomogram demonstrated a significant correlation between estimated and actual visceral recurrence-free survival (c-index = 0.85; P < 0.001; 95% CI, 0.80–0.89).
Figure 5
Figure 5. Predictive model for 5-year cancer-specific survival
The nomogram including age, sex, preoperative CKD, hydronephrosis, tumor location, pT, lymphovascular invasion (LVI), surgical margin, cN+ or pN+ for predicting 5-year cancer-specific survival is shown. The calculation for 5-year visceral recurrence-free survival probability in the case of 70-year-old male patients who underwent radical nephroureterectomy with bladder cuff excision with preoperative CKD, hydronephrosis, ureter tumor, pT3, LVI, negative surgical margin, and negative in cN or pN provided a value of 45%. The nomogram demonstrated a significant correlation between estimated and actual visceral recurrence-free survival (c-index = 0.83; P < 0.001; 95% CI, 0.78–0.89).
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