Kuo-Hua Lee1,2, Yung-Tai Chen1,3, Hsiao-Jen Chung1,4, Jia-Sin Liu5, Chih-Cheng Hsu5, Der-Cherng Tarng1,2,6,7. 1. a School of Medicine, National Yang-Ming University , Taipei , Taiwan . 2. b Division of Nephrology , Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan . 3. c Department of Medicine , Taipei City Hospital Heping Fuyou Branch , Taipei , Taiwan . 4. d Department of Urology , Taipei Veterans General Hospital , Taipei , Taiwan . 5. e Division of Preventive Medicine and Health Services Research , Institute of Population Health Sciences, National Health Research Institutes , Zhunan , Taiwan . 6. f Department and Institute of Physiology , National Yang-Ming University , Taipei , Taiwan , and. 7. g Genome, Infection and Immunity Research Center, National Yang-Ming University , Taipei , Taiwan.
Abstract
OBJECTIVES: To compare the renal outcomes in patients of unilateral renal cell carcinoma (RCC) with upper tract urothelial carcinoma (UTUC) following surgical resection of the tumor-bearing kidney, and to investigate the potential predictors in renal function decline. PATIENTS AND METHODS: In this retrospective cohort study, 319 RCC patients undergoing radical nephrectomy (RN) and 297 UTUC patients undergoing radical nephroureterectomy were recruited from a tertiary medical center between 2001 and 2010. Demographic data, co-morbidity, smoking habit, baseline estimated glomerular filtration rate (eGFR) calculated by chronic kidney disease-epidemiology equation, as well as tumor staging of RCC and UTUC, were recorded. The primary endpoint was serum creatinine doubling and/or end-stage renal disease (ESRD) necessitating long-term dialysis. Cox proportional hazard model and Fine and Gray's competing risk regression accounting for death were used to model renal outcome. RESULTS: UTUC patients had a higher incidence rate of renal function deterioration than RCC patients did (15.01 vs. 2.68 per 100 person-years, p<0.001). In Cox proportional hazard model and Fine and Gray's competing risk regression, UTUC was significantly associated with increased risk of creatinine doubling and/or ESRD necessitating dialysis (hazard ratio, 3.13; 95% confidence interval, 2.01-4.87) as compared to RCC following unilateral RN. Nevertheless, our study is observational in nature and cannot prove causality. CONCLUSIONS: UTUC per se is strongly associated with kidney disease progression as compared to RCC following unilateral nephrectomy. Further studies are needed to elucidate this association.
OBJECTIVES: To compare the renal outcomes in patients of unilateral renal cell carcinoma (RCC) with upper tract urothelial carcinoma (UTUC) following surgical resection of the tumor-bearing kidney, and to investigate the potential predictors in renal function decline. PATIENTS AND METHODS: In this retrospective cohort study, 319 RCCpatients undergoing radical nephrectomy (RN) and 297 UTUC patients undergoing radical nephroureterectomy were recruited from a tertiary medical center between 2001 and 2010. Demographic data, co-morbidity, smoking habit, baseline estimated glomerular filtration rate (eGFR) calculated by chronic kidney disease-epidemiology equation, as well as tumor staging of RCC and UTUC, were recorded. The primary endpoint was serum creatinine doubling and/or end-stage renal disease (ESRD) necessitating long-term dialysis. Cox proportional hazard model and Fine and Gray's competing risk regression accounting for death were used to model renal outcome. RESULTS: UTUC patients had a higher incidence rate of renal function deterioration than RCCpatients did (15.01 vs. 2.68 per 100 person-years, p<0.001). In Cox proportional hazard model and Fine and Gray's competing risk regression, UTUC was significantly associated with increased risk of creatinine doubling and/or ESRD necessitating dialysis (hazard ratio, 3.13; 95% confidence interval, 2.01-4.87) as compared to RCC following unilateral RN. Nevertheless, our study is observational in nature and cannot prove causality. CONCLUSIONS: UTUC per se is strongly associated with kidney disease progression as compared to RCC following unilateral nephrectomy. Further studies are needed to elucidate this association.
Authors: Ho Song Yu; Jun Eul Hwang; Ho Seok Chung; Yang Hyun Cho; Myung Soo Kim; Eu Chang Hwang; Kyung Jin Oh; Sun-Ouck Kim; Seung Il Jung; Taek Won Kang; Dong Deuk Kwon; Kwangsung Park; Soo Bang Ryu; Sung-Hoon Jung; Young Hoe Hur; Joon Hwa Noh; Myung Ki Kim; Ill Young Seo; Chul-Sung Kim; Sung Gu Kang; Seok Ho Kang; Jun Cheon Journal: Oncotarget Date: 2017-03-15