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

Katsuki Muramoto; Fumihiko Urabe; Yuhei Koike; Shutaro Yamamoto; Hirotaka Suzuki; Keiichiro Miyajima; Wataru Fukuokaya; Kosuke Iwatani; Yu Imai; Taro Igarashi; Keiichiro Mori; Koichi Aikawa; Shoji Kimura; Kojiro Tashiro; Yuta Yamada; Takaya Sasaki; Shun Sato; Steffi Kar Kei Yuen; Tatsuya Shimomura; Akira Furuta; Shunsuke Tsuzuki; Jun Miki; Takahiro Kimura; JIKEI-YAYOI Collaborative Group

doi:10.1016/j.urolonc.2024.04.001

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

Urol Oncol. 2024 May 9:S1078-1439(24)00421-6. doi: 10.1016/j.urolonc.2024.04.001. Online ahead of print.

Authors

Katsuki Muramoto¹, Fumihiko Urabe², Yuhei Koike¹, Shutaro Yamamoto¹, Hirotaka Suzuki¹, Keiichiro Miyajima¹, Wataru Fukuokaya¹, Kosuke Iwatani³, Yu Imai¹, Taro Igarashi¹, Keiichiro Mori¹, Koichi Aikawa¹, Shoji Kimura³, Kojiro Tashiro⁴, Yuta Yamada⁵, Takaya Sasaki⁶, Shun Sato⁷, Steffi Kar Kei Yuen⁸, Tatsuya Shimomura¹, Akira Furuta¹, Shunsuke Tsuzuki¹, Jun Miki³, Takahiro Kimura¹; JIKEI-YAYOI Collaborative Group

Affiliations

¹ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
² Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: furabe0809@gmail.com.
³ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan.
⁴ Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan.
⁵ Department of Urology, University of Tokyo, Tokyo, Japan.
⁶ Department of Nephrology and Hypertension, The Jikei University School of Medicine, Tokyo, Japan.
⁷ Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.
⁸ S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.

PMID: 38729868
DOI: 10.1016/j.urolonc.2024.04.001

Abstract

Background: The effect of radical nephroureterectomy (RNUx) on postoperative renal function in patients diagnosed with upper tract urothelial carcinoma (UTUC) has not been thoroughly explored.

Methods: 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).

Results: 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 <60 ml/min/1.73 m² demonstrated significantly lower odds of a postoperative decline in eGFR of 25% or more. The effect of comorbidities on postoperative eGFR at 1 year was significant (P = 0.048). The 3-year NUTRFS, CSS, and OS rates were 72.9%, 85.2%, and 81.5%, respectively. Preoperative chronic kidney disease was an independent factor associated with inferior NUTRFS, CSS, and OS.

Conclusion: Different degrees of impairment of renal function occur among UTUC patients. 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. In addition, the presence of comorbidities had a significant effect on the decline in eGFR. These findings emphasize the importance of developing evidence-based perioperative treatment strategies for UTUC patients with impaired renal function.

Keywords: Chronic kidney disease; Renal function; Upper tract urothelial carcinoma.