Kohei Kobatake1, Tetsutaro Hayashi1, Peter C Black2, Keisuke Goto1,3, Kazuhiro Sentani4, Mayumi Kaneko5, Wataru Yasui4, Koji Mita6, Jun Teishima1, Akio Matsubara1. 1. Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 2. The Vancouver Prostate Center and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 3. Thoracic Oncology and Cancer Biology Program, University of Hawai'i Cancer Center, Honolulu, Hawaii. 4. Department of Molecular Pathology, Graduate School of Biochemical and Health Sciences, Hiroshima University, Hiroshima, Japan. 5. Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 6. Department of Urology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Abstract
OBJECTIVES: To investigate the relationship between chronic kidney disease and primary non-muscle-invasive bladder cancer. METHODS: Disease outcomes were analyzed in 418 patients treated with transurethral resection for primary non-muscle-invasive bladder cancer, and were correlated to traditional risk factors as well as chronic kidney disease stage according to estimated glomerular filtration rate: ≥60 (G1-2), 45-59 (G3a) or <45 (G3b-5). RESULTS: The median follow-up time was 40.0 months. There were 287 (68.7%), 98 (23.4%), and 33 (7.9%) patients with G1-2, G3a and G3b-5 chronic kidney disease, respectively. T1 tumor was present in 29.6% of G1-2, 43.9% of G3a and 51.4% of G3b-5 chronic kidney disease (P = 0.004). The proportion of histological grade 3 non-muscle-invasive bladder cancer was higher in G3a and G3b-5 than G1-2 (P < 0.001). Higher chronic kidney disease stage was associated with worse recurrence-free (P < 0.001) and progression-free survival (P = 0.017). In multivariable analysis, G3b-5 was found to be an independent predictor for recurrence (hazard ratio 1.87; P = 0.004) and progression (hazard ratio 2.96; P = 0.019). Chronic kidney disease stage was also strongly associated with the European Association of Urology bladder cancer risk groups (P < 0.001), and with shorter time to recurrence and progression in each group. CONCLUSIONS: Chronic kidney disease predicts the clinical outcome of primary non-muscle-invasive bladder cancer. Adding chronic kidney disease to the conventional risk factors might increase the accuracy of risk stratification.
OBJECTIVES: To investigate the relationship between chronic kidney disease and primary non-muscle-invasive bladder cancer. METHODS: Disease outcomes were analyzed in 418 patients treated with transurethral resection for primary non-muscle-invasive bladder cancer, and were correlated to traditional risk factors as well as chronic kidney disease stage according to estimated glomerular filtration rate: ≥60 (G1-2), 45-59 (G3a) or <45 (G3b-5). RESULTS: The median follow-up time was 40.0 months. There were 287 (68.7%), 98 (23.4%), and 33 (7.9%) patients with G1-2, G3a and G3b-5 chronic kidney disease, respectively. T1 tumor was present in 29.6% of G1-2, 43.9% of G3a and 51.4% of G3b-5 chronic kidney disease (P = 0.004). The proportion of histological grade 3 non-muscle-invasive bladder cancer was higher in G3a and G3b-5 than G1-2 (P < 0.001). Higher chronic kidney disease stage was associated with worse recurrence-free (P < 0.001) and progression-free survival (P = 0.017). In multivariable analysis, G3b-5 was found to be an independent predictor for recurrence (hazard ratio 1.87; P = 0.004) and progression (hazard ratio 2.96; P = 0.019). Chronic kidney disease stage was also strongly associated with the European Association of Urology bladder cancer risk groups (P < 0.001), and with shorter time to recurrence and progression in each group. CONCLUSIONS:Chronic kidney disease predicts the clinical outcome of primary non-muscle-invasive bladder cancer. Adding chronic kidney disease to the conventional risk factors might increase the accuracy of risk stratification.
Authors: Sang Won Lee; Bum Sik Tae; Yoon Ji Choi; Sang Min Yoon; Yoon Sook Lee; Jae Hwan Kim; Hye Won Shin; Jae Young Park; Jae Hyun Bae Journal: J Clin Med Date: 2022-02-21 Impact factor: 4.241