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World Journal of Urology

, Volume 36, Issue 2, pp 249–256 | Cite as

Preoperative chronic kidney disease is predictive of oncological outcome of radical cystectomy for bladder cancer

  • Akihiko Matsumoto
  • Tohru NakagawaEmail author
  • Atsushi Kanatani
  • Masaomi Ikeda
  • Taketo Kawai
  • Jimpei Miyakawa
  • Satoru Taguchi
  • Akihiro Naito
  • Masafumi Otsuka
  • Yasukazu Nakanishi
  • Motofumi Suzuki
  • Fumitaka Koga
  • Yasushi Nagase
  • Yasushi Kondo
  • Toshikazu Okaneya
  • Yoshinori Tanaka
  • Hideyo Miyazaki
  • Tetsuya Fujimura
  • Hiroshi Fukuhara
  • Haruki Kume
  • Yasuhiko Igawa
  • Yukio Homma
Original Article

Abstract

Purpose

To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes after radical cystectomy (RC) for bladder cancer.

Methods

We reviewed the medical records of patients with urothelial bladder carcinoma who underwent RC with curative intent at seven hospitals between 1990 and 2013. After excluding patients with a history of upper urinary tract urothelial cancer or neoadjuvant chemotherapy, we analyzed 594 cases for the study. Preoperative estimated glomerular filtration rate (eGFR) was calculated using the three-variable Japanese equation for GFR estimation from serum creatinine level and age. Patients were divided into four groups of different CKD stages based on eGFR values (mL/min/1.73 m2), i.e., ≥ 60 (CKD stages G1–2), 45–60 (G3a), 30–45 (G3b), and < 30 (G4–5). Survival was estimated using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards regression analyses addressed survivals after RC.

Results

Median age of patients was 67 years. Patients were classified into CKD stages: G1–2 (n = 388; 65.3%), G3a (n = 122; 20.5%), G3b (n = 51; 8.6%), and G4–5 (n = 33; 5.6%). During a median follow-up of 4.0 years, 200 and 164 patients showed cancer progression and died of bladder cancer, with the 5-year progression-free survival (PFS) and cancer-specific survival (CSS) of 64.9 and 70.2%, respectively. On multivariate analyses, CKD stages of G3b or greater, advanced pT stage, lymph node metastasis, and positive lymphovascular invasion were independent poor prognostic factors for PFS and CSS.

Conclusions

We demonstrated that the advanced preoperative CKD stage was significantly associated with poor oncological outcomes of the bladder cancer after RC.

Keywords

Bladder cancer Chronic kidney disease Radical cystectomy Cancer-specific survival Progression-free survival 

Abbreviations

RC

Radical cystectomy

UCB

Urothelial cancer of the bladder

CKD

Chronic kidney disease

UTUC

Upper tract urothelial cancer

LVI

Lymphovascular invasion

PFS

Progression-free survival

CSS

Cancer-specific survival

OS

Overall survival

Notes

Acknowledgements

Dr. Kyoichi Tomita, Department of Urology, Japanese Red Cross Medical Center, provided insights. Tomiko Ozawa, Tokyo Metropolitan Bokutoh Hospital, assisted database management.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the institutional review board of each participating institute and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author’s contribution

AM was involved in project development, data collection, data analysis, and manuscript writing. TN contributed to project development, data analysis, and manuscript writing. AK, MI, TK, JM, ST, AN, MO, YN, and YK were all involved in data collection, data analysis, and manuscript editing. MS, FK, YN, TO, and YT contributed to data analysis and manuscript editing. HM, TF, HF, HK, and YI edited the manuscript. YH performed the manuscript editing, administrative support, and supervision.

Supplementary material

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Supplementary material 1 (TIFF 947 kb)
345_2017_2141_MOESM2_ESM.tif (592 kb)
Supplementary material 2 (TIFF 592 kb)
345_2017_2141_MOESM3_ESM.docx (24 kb)
Supplementary material 3 (DOCX 23 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Akihiko Matsumoto
    • 1
    • 2
    • 3
  • Tohru Nakagawa
    • 1
    Email author
  • Atsushi Kanatani
    • 1
  • Masaomi Ikeda
    • 4
  • Taketo Kawai
    • 1
    • 5
  • Jimpei Miyakawa
    • 1
    • 6
  • Satoru Taguchi
    • 1
    • 6
  • Akihiro Naito
    • 1
    • 3
  • Masafumi Otsuka
    • 1
    • 5
  • Yasukazu Nakanishi
    • 2
  • Motofumi Suzuki
    • 6
  • Fumitaka Koga
    • 2
  • Yasushi Nagase
    • 3
  • Yasushi Kondo
    • 7
  • Toshikazu Okaneya
    • 4
  • Yoshinori Tanaka
    • 5
  • Hideyo Miyazaki
    • 1
  • Tetsuya Fujimura
    • 1
  • Hiroshi Fukuhara
    • 1
  • Haruki Kume
    • 1
  • Yasuhiko Igawa
    • 8
  • Yukio Homma
    • 1
  1. 1.Department of Urology, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of UrologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  3. 3.Department of UrologyTokyo Metropolitan Tama Medical CenterTokyoJapan
  4. 4.Department of UrologyToranomon HospitalTokyoJapan
  5. 5.Department of UrologyJapanese Red Cross Musashino HospitalTokyoJapan
  6. 6.Department of UrologyTokyo Teishin HospitalTokyoJapan
  7. 7.Department of UrologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
  8. 8.Department of Continence MedicineThe University of Tokyo Graduate School of MedicineTokyoJapan

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