Preoperative hydronephrosis is an independent protective factor of renal function decline after nephroureterectomy for upper tract urothelial carcinoma

Pai-Yu Cheng; Hsiang-Ying Lee; Wei-Ming Li; Steven K Huang; Chien-Liang Liu; I-Hsuan Alan Chen; Jen-Tai Lin; Chi-Wen Lo; Chih-Chin Yu; Shian-Shiang Wang; Chuan-Shu Chen; Jen-Shu Tseng; Wun-Rong Lin; Jou Yeong-Chin; Ian-Seng Cheong; Yuan-Hong Jiang; Yu Khun Lee; Yung-Tai Chen; Shin-Hong Chen; Bing-Juin Chiang; Thomas Y Hsueh; Chao-Yuan Huang; Chia-Chang Wu; Wei Yu Lin; Yao-Chou Tsai; Kai-Jie Yu; Chi-Ping Huang; Yi-You Huang; Chung-You Tsai

doi:10.3389/fonc.2023.944321

Preoperative hydronephrosis is an independent protective factor of renal function decline after nephroureterectomy for upper tract urothelial carcinoma

Front Oncol. 2023 Feb 24:13:944321. doi: 10.3389/fonc.2023.944321. eCollection 2023.

Authors

Pai-Yu Cheng^{1

2}, Hsiang-Ying Lee^{3

4

5

6}, Wei-Ming Li^{3

4

7

8

9}, Steven K Huang^{10

11}, Chien-Liang Liu¹⁰, I-Hsuan Alan Chen¹², Jen-Tai Lin¹², Chi-Wen Lo¹³, Chih-Chin Yu^{13

14}, Shian-Shiang Wang^{15

16

17}, Chuan-Shu Chen^{15

16

18}, Jen-Shu Tseng^{19

20

21}, Wun-Rong Lin^{19

20}, Jou Yeong-Chin^{22

23}, Ian-Seng Cheong²², Yuan-Hong Jiang²⁴, Yu Khun Lee²⁴, Yung-Tai Chen²⁵, Shin-Hong Chen²⁵, Bing-Juin Chiang^{26

27

28}, Thomas Y Hsueh^{29

30}, Chao-Yuan Huang³¹, Chia-Chang Wu^{32

33

34}, Wei Yu Lin^{35

36

37}, Yao-Chou Tsai^{14

38

39}, Kai-Jie Yu^{40

41

42}, Chi-Ping Huang^{43

44}, Yi-You Huang¹, Chung-You Tsai^{2

45}

Affiliations

¹ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
² Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁶ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.
⁹ Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
¹¹ Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
¹² Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹³ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.
¹⁴ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹⁵ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
¹⁶ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁷ Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan.
¹⁸ Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan.
¹⁹ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
²⁰ Mackay Medical College, Taipei, Taiwan.
²¹ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²² Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
²³ Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan.
²⁴ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
²⁵ Department of Urology Taiwan Adventist Hospital, Taipei, Taiwan.
²⁶ College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
²⁷ Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
²⁸ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
²⁹ Division of Urology, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan.
³⁰ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³¹ Department of Urology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³² Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³³ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³⁴ TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³⁵ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
³⁶ Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
³⁷ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³⁸ Department of Surgery, Taipei Tzu chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
³⁹ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
⁴⁰ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴¹ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴² Department of Chemical Engineering and Biotechnology and Graduate Institute of Biochemical and Biomedical Engineering, National Taipei University of Technology, Taipei, Taiwan.
⁴³ Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
⁴⁴ School of Medicine, China Medical University, Taichung, Taiwan.
⁴⁵ Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.

Abstract

Objectives: To evaluate the predictive role of pre-nephroureterectomy (NU) hydronephrosis on post-NU renal function (RF) change and preserved eligibility rate for adjuvant therapy in patients with upper tract urothelial carcinoma (UTUC).

Patients and methods: This retrospective study collected data of 1018 patients from the Taiwan UTUC Collaboration Group registry of 26 institutions. The patients were divided into two groups based on the absence or presence of pre-NU hydronephrosis. Estimated glomerular filtration rate (eGFR) was calculated pre- and post-NU respectively. The one month post-NU RF change, chronic kidney disease (CKD) progression, and the preserved eligibility rate for adjuvant therapy were compared for each CKD stage.

Results: 404 (39.2%) patients without and 614 (60.8%) patients with pre-NU hydronephrosis were enrolled. The median post-NU change in the eGFR was significantly lower in the hydronephrosis group (-3.84 versus -12.88, p<0.001). Pre-NU hydronephrosis was associated with a lower post-NU CKD progression rate (33.1% versus 50.7%, p< 0.001) and was an independent protective factor for RF decline after covariate adjustment (OR=0.46, p<0.001). Patients with pre-NU hydronephrosis had a higher preserved eligibility rate for either adjuvant cisplatin-based chemotherapy (OR=3.09, 95%CI 1.95-4.69) or immune-oncology therapy (OR=2.31, 95%CI 1.23-4.34).

Conclusion: Pre-NU hydronephrosis is an independent protective predictor for post-NU RF decline, CKD progression, and eligibility for adjuvant therapy. With cautious selection for those unfavorably prognostic, non-metastatic UTUC patients with preoperative hydronephrosis, adjuvant rather than neoadjuvant therapy could be considered due to higher chance of preserving eligibility.

Keywords: adjuvant therapy; chronic kidney disease; cisplatin-based chemotherapy; hydronephrosis; immune-oncology therapy; nephroureterectomy; renal function; upper tract urothelial carcinoma.