The impact of post-nephroureterectomy surgically induced chronic kidney disease on survival outcomes.

Autor: Puri D; Department of Urology, UC San Diego School of Medicine, La Jolla, California, USA., Meagher MF; Department of Urology, UC San Diego School of Medicine, La Jolla, California, USA., Wu Z; Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Franco A; Department of Urology, Rush University, Chicago, Illinois, USA., Wang L; Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Margulis V; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Bhanvadia R; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Abdollah F; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA., Finati M; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA., Antonelli A; Department of Urology, University of Verona, Verona, Italy., Ditonno F; Department of Urology, University of Verona, Verona, Italy., Singla N; Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Broenimann S; Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Simone G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Tuderti G; Department of Urology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy., Rais-Bahrami S; Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA., Moon SC; Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA., Ferro M; Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy., Tozzi M; Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy., Porpiglia F; Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy., Amparore D; Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy., Correa A; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA., Helstrom E; Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA., Gonzalgo ML; Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA., Mendiola DF; Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA., Perdonà S; Uro-Gynecological Department, Fondazione 'G. Pascale'; IRCCS, Naples, Italy., Tufano A; Uro-Gynecological Department, Fondazione 'G. Pascale'; IRCCS, Naples, Italy., Eilender BM; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA., Mehrazin R; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA., Yong C; Department of Urology, Indiana University, Indianapolis, Indiana, USA., Ghoreifi A; Institute of Urology, University of Southern California, Los Angeles, California, USA., Sundaram CP; Department of Urology, Indiana University, Indianapolis, Indiana, USA., Djaladat H; Institute of Urology, University of Southern California, Los Angeles, California, USA., Autorino R; Department of Urology, Rush University, Chicago, Illinois, USA., Derweesh IH; Department of Urology, UC San Diego School of Medicine, La Jolla, California, USA.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Dec 11. Date of Electronic Publication: 2024 Dec 11.
DOI: 10.1111/bju.16569
Abstrakt: Objective: To investigate the prevalence, predictors and impact of surgically induced chronic kidney disease (CKD-S) on survival outcomes in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).
Methods: Utilising the ROBUUST 2.0 registry, a multicentre retrospective analysis was conducted in patients with UTUC undergoing RNU between 2006 and 2022 who did not have baseline chronic kidney disease (CKD) stages 3-5. We calculated the prevalence of postoperative CKD-S3a (estimated glomerular filtration rate [eGFR] 59-45 mL/min/1.73 m 2 ) and CKD-S3b (eGFR <45 mL/min/1.73 m 2 ) as measured by the Chronic Kidney Disease Epidemiology Collaboration 2021 equation. The analytical cohort was stratified by postoperative CKD stage [no CKD-S [eGFR ≥60 mL/min/1.73 m 2 ]; CKD-S3a [eGFR 59-45 mL/min/1.73 m 2 ] and CKD-S3b [eGFR <45 mL/min/1.73 m 2 ]). The primary outcome was all-cause mortality (ACM). Predictors for development of CKD-S3a/3b and ACM/cancer-specific mortality (CSM) were analysed using logistic and Cox regression, respectively. Kaplan-Meier analysis was used to analyse overall survival (OS) and cancer-specific survival (CSS) among postoperative CKD groups.
Results: We analysed 1862 patients; 34.7% (646) and 39.6% (738), respectively, developed CKD-S3a and CKD-S3b. Predictors of CKD-S3b included increasing age (odds ratio [OR] 1.03, P = 0.029), decreasing preoperative eGFR (OR 1.06, P < 0.001) and receipt of neoadjuvant (OR 2.07, P = 0.006) and adjuvant chemotherapy (OR 1.41, P = 0.012). Worsened ACM was associated with CKD-S3b (hazard ratio 1.42, P = 0.032), but not CKD-S3a (P = 0.766). Development of CKD-S3a (P = 0.812) and CKD-S3b (P = 0.316) were not associated with CSM. The 5-year OS rate was significantly worse in CKD-S3b (no-CKD 71%, CKD-S3a 70%, CKD-S3b 59%; P = 0.017). No differences between CKD-S groups were noted for 5-year CSS (no-CKD 78%, CKD-S3a 77%, CKD-S3b 82%; P = 0.44).
Conclusions: A significant proportion of UTUC patients undergoing RNU developed CKD-S. Development of CKD-S3b was associated with worse ACM. Increasing age, preoperative eGFR, and chemotherapy were associated with developing CKD-S3b. Our findings call for further exploration and refinement of nephron-preserving surgical strategies and non-nephrotoxic systemic therapy to improve survival outcomes in UTUC.
(© 2024 BJU International.)
Databáze: MEDLINE
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