Nephroureterectomy increase 5 year survival in patients on dialysis with upper urinary tract urothelial carcinoma

Cih-En Huang; Yao-Hsu Yang; Wen-Cheng Chen; Kuo-Tsai Huang; Pau-Chung Chen; Ying-Huang Tsai; Wei-Yu Lin

doi:10.18632/oncotarget.20180

Nephroureterectomy increase 5 year survival in patients on dialysis with upper urinary tract urothelial carcinoma

Oncotarget. 2017 Aug 11;8(45):79876-79883. doi: 10.18632/oncotarget.20180. eCollection 2017 Oct 3.

Authors

Cih-En Huang^{1

2

3}, Yao-Hsu Yang^{4

5

6}, Wen-Cheng Chen^{5

7

8}, Kuo-Tsai Huang⁹, Pau-Chung Chen^{5

10

11

12}, Ying-Huang Tsai^{13

14}, Wei-Yu Lin^{3

8

9}

Affiliations

¹ Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
² Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
³ Chang Gung University of Science and Technology, Chiayi, Taiwan.
⁴ Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁵ Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁶ School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁸ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁹ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁰ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
¹¹ Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
¹² Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
¹³ Division of Pulmonary and Critical Care Medicine, Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁴ Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan.

Abstract

Background: There is a high incidence rate of upper tract urothelial carcinoma (UTUC) in patients on dialysis. However, the studies about nephroureterectomy (NU) in this high surgical risk group are limited. The aim of this study is to investigate the outcomes of NU in this population.

Results: There were total 931 patients enrolled and 218, 582, 131 patients were non-NU, unilateral and one-stage bilateral NU, respectively. NU provided better 5-year overall survival (66% versus 51% in non-NU, P = 0.001). 19.7% of patients with unilateral NU had successive contralateral NU with a mean interval period of 695 days. Even for the elderly, there were no significant difference in duration of hospitalization, 30- and 90-day mortality between unilateral and bilateral NU.

Materials and methods: Patients on dialysis with UTUC between January 1998 and December 2012 were assessed from the nationwide cohort of Taiwan National Health Insurance Research Database. We classified these patients into non-NU and NU groups. In NU group, we analyzed clinical outcomes of patient groups between different NU types and surgical methods.

Conclusions: Although the high surgical risk in patients on dialysis with UTUC, NU provided better 5-year overall survival. One-stage bilateral NU both provides comparable safety profile and avoids 19.7% of successive contralateral NU in less than two years. Even in the elderly, one-stage bilateral NU is safe and feasible.

Keywords: dialysis; elderly; nephroureterectomy; upper tract urothelium carcinoma.