Presentation Authors: Naoki Fujita*, Masaki Momota, Yuki Tobisawa, Tohru Yoneyama, Hayato Yamamoto, Atsushi Imai, Shingo Hatakeyama, Hirosaki, Japan, Hiroyuki Ito, Hachinohe, Japan, Takahiro Yoneyama, Yasuhiro Hashimoto, Chikara Ohyama, Hirosaki, Japan
Introduction: Previous studies reported preoperative renal insufficiency indicated poor prognosis in upper urinary tract carcinoma and muscle-invasive bladder cancer (MIBC). However, little is known about the influence of preoperative renal insufficiency on oncological outcomes in patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the present study was to evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in primary NMIBC patients who underwent trans-urethral resection of bladder tumor (TURBT).
Methods: A total of 402 patients with primary NMIBC who underwent TURBT from November 1993 to September 2018 were examined retrospectively. Patients were divided into two groups between patients with preoperative estimated glomerular filtration rate (eGFR) â‰¥60mL/min/1.73m2 (non-CKD group) and < 60mL/min/1.73m2 (CKD group). We investigated oncological outcomes, including intra-vesical and upper urinary tract recurrence-free survival (RFS), MIBC-free survival and metastasis-free survival. We performed multivariate Cox regression analyses using inverse probability of treatment weighting (IPTW) method to evaluate the impact of preoperative CKD status on prognosis.
Results: Median age was 72 years, and median follow-up periods were 47 months in this cohort. Of the 402 patients, 130 (32%) were diagnosed as CKD before TURBT. Intra-vesical and upper urinary tract RFS, MIBC-free survival and metastasis-free survival after TURBT were significantly lower in CKD group compared to non-CKD group. In multivariate analyses using IPTW model, CKD status was selected as a significant independent risk factor of intra-vesical recurrence, progression to MIBC and metastasis in primary NMIBC patients who underwent TURBT, whereas not selected in upper urinary tract recurrence.
Conclusions: Presence of preoperative CKD may be a potential risk factor for post-TURBT recurrence and progression in patients with primary NMIBC.