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 and Chikara Ohyama 1, 3 1 Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan 2 Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan 3 Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan 4 Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan 5 Department of Urology, Mutsu General Hospital, Mutsu, Japan 6 Department of Urology, Tsugaru General Hospital, Goshogawara, Japan 7 Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan Correspondence to: Shingo Hatakeyama, email: shingoh@hirosaki-u.ac.jp Keywords: upper urinary tract urothelial carcinoma, radical nephroureterectomy, chronic kidney disease, renal function, oncological outcome Received: July 19, 2017 Accepted: July 28, 2017 Published: August 24, 2017 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.