Prevalence of Chronic Kidney Disease in Upper Tract Urothelial Carcinoma Endemic Area and its Oncological Impact in Real World
I-Wen Lee, Hung-Jen Wang, Wei-Ching Lee, Yao-Chi Chuang, Yen-Ta Chen, Yuan-Tso Cheng, Chih-Hsiung Kang, Wei-Chia Lee, Chien-Hsu Chen, Yuan-Chi Shen, Yi Yang Liu, Hui Ying Liu, Yin Lun Chang, Wen-Chou Yang, Po-Hui Chiang, Hao-Lun Luo*
Kaohsiung Chang Gung Memorial Hospital, Department of Urology, Kaohsiung, Taiwan
Purpose: To evaluate the oncological impact of preoperative chronic kidney disease (CKD) in upper tract urothelial carcinoma (UTUC) patients who received radical nephroureterectomy (RNU).
Materials and methods: This study enrolled total 1172 patients with UTUC treated with RNU in a single center in Taiwan between 2005 February and 2019 August. They were separated into two groups, including CKD <= 3 (811 patients) and CKD >3 (361 patients) respectively. Estimated glomerular filtration rate (eGFR) was calculated by Modification of Diet in Renal Disease (MDRD) formulas. Oncological impacts, including intravesical recurrence, metastasis and cancer specific mortality stratified by preoperative CKD status (CKD >3 vs. CKD <=3) were investigated.
Results: The main finding was that UTUC with CKD stage >3 patients in Taiwan were female predominance (P<0.001), with more concurrent bladder cancer history (P=0.003), with more multifocal tumor behavior (P<0.001), with more carcinoma in situ (P=0.008), with more intravesical recurrence (P<0.001), with less smoking history (P=0.003), received less adjuvant chemotherapy (P<0.001), with less distant metastasis (P<0.001) and less cancer specific mortality (P=0.006) than the patients with CKD stage <=3. However, the multivariate Cox regression analysis disclosed that intravesical recurrence (P=0.014) and metastasis (P=0.006) has reached significant difference between CKD stage >3 and stage <=3. Our study also pointed out that the patients with concurrent bladder cancer and variant histology have higher intravesical recurrence, metastasis and cancer specific mortality. CKD stage >3 group have less intravesical recurrence (P=0.0014), more distant metastasis (P<0.0001) and cancer specific mortality (P=0.0091) than stage <=3 group in 5-year free survival curves.
Conclusion: In UTUC endemic area, such as Taiwan, we discovered that UTUC patients with CKD > 3 status have higher intravesical recurrence, more carcinoma in situ and multifocal tumor behavior, but less distant metastasis and cancer specific mortality in our study. These results may inform us that we should take different strategy for managing UTUC patients with preoperative renal insufficiency in UTUC endemic region.