Perioperative renal function change and oncological outcomes of radical nephroureterectomy in patients with upper tract urothelial carcinoma: A multicenter retrospective study

• Published in: Urologic oncology 2024-10, Vol.42 (10), p.332.e21-332.e32
• Main Authors: Muramoto, Katsuki, Urabe, Fumihiko, Koike, Yuhei, Yamamoto, Shutaro, Suzuki, Hirotaka, Miyajima, Keiichiro, Fukuokaya, Wataru, Iwatani, Kosuke, Imai, Yu, Igarashi, Taro, Mori, Keiichiro, Aikawa, Koichi, Kimura, Shoji, Tashiro, Kojiro, Yamada, Yuta, Sasaki, Takaya, Sato, Shun, Yuen, Steffi Kar Kei, Shimomura, Tatsuya, Furuta, Akira, Tsuzuki, Shunsuke, Miki, Jun, Kimura, Takahiro
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - surgery; Chronic kidney disease; Female; Glomerular Filtration Rate; Humans; Kidney - physiopathology; Kidney - surgery; Kidney Neoplasms - physiopathology; Kidney Neoplasms - surgery; Male; Middle Aged; Nephroureterectomy - methods; Renal function; Retrospective Studies; Treatment Outcome; Upper tract urothelial carcinoma; Ureteral Neoplasms - complications; Ureteral Neoplasms - mortality; Ureteral Neoplasms - surgery
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2024.04.001

•The eligibility for cisplatin therapy before and after nephroureterectomy becomes crucial in the decision-making process.•Only 5.1% of patients retain a postoperative eGFR ≥60 ml/min/1.73 m2.•Preoperative renal impairment was linked to reduced odds of postoperative eGFR decrease and associated with survival.•The presence of comorbidities (diabetes mellitus and hypertension) had a significant effect on the decline in eGFR. The effect of radical nephroureterectomy (RNUx) on postoperative renal function in patients diagnosed with upper tract urothelial carcinoma (UTUC) has not been thoroughly explored. We conducted a retrospective analysis including 785 patients who underwent RNUx for UTUC. We assessed the preoperative and postoperative estimated glomerular filtration rates (eGFRs) and factors related to the decline in eGFR. Additionally, we examined the effect of comorbidities (diabetes or hypertension) on the postoperative eGFR at 1 year. Cox proportional hazard models were employed to investigate the clinical effect of RNUx on oncological outcomes, including non-urothelial tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). The median preoperative and postoperative eGFR levels were 54.7 and 40.6 ml/min/1.73 m2 respectively. The proportions of patients with preoperative and postoperative eGFR ≥60 mL/min/1.73 m2 were 35.9% and 5.1%, respectively. The median decline in the eGFR after surgery was 26.8%. Patients with preoperative eGFR