Chronic kidney disease and radical cystectomy for bladder cancer: perioperative and oncologic outcomes in 1,214 patients

Charles Nguyen; Saum Ghodoussipour; Matthew Winter; Giovanni Cacciamani; Hamed Ahmadi; Hooman Djaladat; Anne K Schuckman; Siamak Daneshmand; Monish Aron; Inderbir Gill; Mihir Desai

doi:10.1016/j.urolonc.2022.04.010

Chronic kidney disease and radical cystectomy for bladder cancer: perioperative and oncologic outcomes in 1,214 patients

Urol Oncol. 2022 Aug;40(8):381.e9-381.e16. doi: 10.1016/j.urolonc.2022.04.010. Epub 2022 May 20.

Affiliations

¹ Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
² Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
³ Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA.
⁴ Keck Medical Center of USC, USC Institute of Urology, University of Southern California, Los Angeles, CA. Electronic address: Mihir.Desai@med.usc.edu.

PMID: 35599109
DOI: 10.1016/j.urolonc.2022.04.010

Abstract

Introduction and objective: To assess the impact of chronic kidney disease (CKD) on outcomes after radical cystectomy (RC) in patients with bladder cancer treated within a high-volume tertiary referral center.

Methods: We identified 1,214 patients who underwent RC with intent to cure from 2009 to 2019. The Modification of Diet in Renal Disease (MDRD) GFR (ml/min/1.73 m²) was calculated and patients were categorized by baseline GFR: Group A = GFR > 60, Group B = GFR > 30-59 and Group C = GFR < 30. Pre-, intra- and postoperative characteristics, oncological outcomes, and 90-day perioperative outcomes were compared. Multivariable logistic regression was used to control for confounding variables.

Results: We identified 722 (59.5%) patients in Group A, 448 (36.9%) in Group B, and 44 (3.6%) in Group C. Patients with worse CKD were older and had significantly worse overall comorbidity (all P < 0.001). Neoadjuvant chemotherapy was used in 352 patients (29%), including 182 (25.2%) in Group A, 153 in Group B (35.3%), and 12 in Group C (27.3%). On univariate analysis, worse CKD was associated with higher pathologic stage, lymph node metastases and positive soft tissue margins (all P < 0.0001). The rates of blood transfusion, 90-day complications and readmissions were higher in patients with worse CKD (P < 0.0001, P = 0.02, P = 0.04, respectively). Patients with worse CKD had worse overall survival (77% vs. 73% vs. 55%, P < 0.0001). On multivariable analysis, worse CKD was independently associated with adverse pathology (≥pT3 or node positive) (OR = 6.96, 95%CI 3.20-15.12), 90-day readmissions (OR 2.09, 95%CI 1.11-3.94) and perioperative transfusion (OR 2.08, 95%CI 1.05-4.11). Receipt of neoadjuvant chemotherapy was significantly associated with a decreased risk of adverse pathology (OR 0.51, 95%CI 0.36-0.74) and increased risk of transfusion (OR 2.24, 95%CI 1.70-2.96), but not with mortality, complications, readmissions or length or stay.

Conclusion: CKD is prevalent in patients undergoing radical cystectomy. We found CKD to be independently associated with a higher likelihood of adverse pathology, 90-day readmissions, and transfusion.

Keywords: Bladder cancer; Chronic kidney disease; Outcomes; Radical cystectomy.

MeSH terms

Blood Transfusion
Cystectomy*
Humans
Neoadjuvant Therapy
Patient Readmission
Postoperative Complications / epidemiology
Renal Insufficiency, Chronic* / complications
Retrospective Studies
Treatment Outcome
Urinary Bladder / pathology
Urinary Bladder Neoplasms* / surgery