The Influence of Chronic Kidney Disease on the Management of Upper Urinary Tract Cancer Following Radical Nephroureterectomy: A Nationwide Multi-Institutional Study.

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Clinical genitourinary cancer Pub Date : 2025-06-30 DOI:10.1016/j.clgc.2025.102394

Chih-Chin Yu, Steven K Huang, Wen-Hsin Tseng, Hung-Lung Ke, Wei-Ming Li, Chao-Hsiang Chang, Wen-Chi Chen, I-Hsuan Alan Chen, Jen-Tai Lin, Jen-Shu Tseng, Wun-Rong Lin, Jian-Hua Hong, Chao-Yuan Huang, Shian-Shiang Wang, Chuan-Shu Chen, Ian-Seng Cheong, Cheng-Huang Shen, Chung-You Tsai, Pai-Yu Cheng, Yuan-Hong Jiang, Yu Khun Lee, Chia-Chang Wu, Thomas Y Hsueh, Yung-Tai Chen, Hsu-Che Huang, Ting-En Tai, Wei Yu Lin, Po-Hung Lin, Chi-Wen Lo, Yao-Chou Tsai

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Abstract

Background: This study aimed to investigate the impact of chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial cancer (UTUC) undergoing radical nephroureterectomy (RNU) in Taiwan.

Methods: We conducted a retrospective cohort study using data from the Taiwan UTUC Collaboration database. 1590 patients who underwent RNU for UTUC were included in the analysis. Patients were categorized into 2 groups: those with adequate renal function and those with preoperative CKD. Overlap weighting was employed to address potential biases and baseline imbalances between the groups. Multivariable Cox regression models were used to analyze overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).

Results: Preoperative CKD was significantly associated with poorer overall survival (HR, 1.372; 95% CI, 1.060-1.775; P = .016) compared to patients with adequate renal function. However, no significant association was observed between CKD and CSS or DFS. Further analysis revealed that patients with advanced CKD had a higher risk of UTUC-related death due to competing risks of non-UTUC-related mortality.

Conclusions: Preoperative CKD in UTUC patients undergoing RNU emerged as the sole risk factor for an inferior OS, without impacting CSS and DFS.

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慢性肾脏疾病对根治性肾输尿管切除术后上尿路癌治疗的影响：一项全国性多机构研究

背景：本研究旨在探讨慢性肾脏疾病（CKD）对台湾接受根治性肾输尿管切除术（RNU）的上路尿路上皮癌（UTUC）患者肿瘤预后的影响。方法：我们使用台湾UTUC合作数据库的资料进行回顾性队列研究。1590例因UTUC接受RNU治疗的患者被纳入分析。患者分为两组：肾功能正常组和术前CKD组。采用重叠加权来解决组间的潜在偏差和基线不平衡。采用多变量Cox回归模型分析总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS）。结果：术前CKD与较差的总生存率显著相关(HR, 1.372；95% ci, 1.060-1.775；P = .016)。然而，CKD与CSS或DFS之间没有明显的关联。进一步的分析显示，由于非utuc相关死亡的竞争风险，晚期CKD患者与utuc相关死亡的风险更高。结论：接受RNU手术的UTUC患者术前CKD是不良OS的唯一危险因素，不影响CSS和DFS。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Clinical genitourinary cancer

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