Inferior survival, higher tumor recurrence and progression rates in primary non-muscle-invasive bladdercancer with impaired egfr
Chia-EnLi2,Hui-Ying Liu 1, Chih-HsiungKang1, Ye-In Chang2, Hsiu-PeiTang2
Department of Urology, Chang Kung Memorial Hospital, Kaohsiung, Taiwan1;
Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan2
Purpose: To evaluate the influence of preoperative patient-associated parameters and comorbidities, with special focus on preoperative renal function on non-muscle-invasive bladder cancer (NMIBC) recurrence, progression, upper urinary tract (UUT) recurrence, cancer specific survival and overall survival.
Materials and Methods: Medical records of 158 patients with first diagnosis of NMIBC from 2008 to 2010 treated at our department were reviewed for tumor stage and grade, comorbidities, and putative risk factors including squamous differentiation, tumor size and count, white blood cell (WBC), neutrophil to lymphocyte ratio (NL ratio), estimated glomerular filtration rate (eGFR) by chronic kidney disease-epidemiology collaboration formula, patient age and gender.
Results: Tumor recurrence was observed in 51 patients (32%) and UUT recurrence was 5 patients (3%); progression to higher pT was found in 9 patients (6%). Univariate analysis revealed count, grade, size, stage, eGFR and squamous differentiation as signification prediction determinants for bladder recurrence. Count, grade, stage, eGFR were signification prediction determinants for progression. Age, grade, stage and eGFR were signification prediction determinants for overall survival. Based on the results of multivariate analysis, a risk factor model was created to classify patients with high and low risk of recurrence, progression and survival.
Conclusions: eGFR, grade and stage are significant predictive variables of NMIBC recurrence, progression and survival. Integrating eGFR into NMIBC risk calculation helped to discriminate individuals with high and low risk of cancer recurrence, progression and survival. Confirmatory studies and external validation are needed to corroborate these findings.