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Note: of interest to Lynch Syndrome patients
abstract
Purpose
To
compare renal function outcomes in patients undergoing radical
nephroureterectomy (RNU) or partial (distal) ureterectomy (PU) for upper
tract urothelial carcinoma (UTUC).
Methods
Clinicopathologic
data of patients undergoing RNU or PU for UTUC from 1998 to 2012 were
compiled. Glomerular filtration rate was calculated preoperatively and
postoperatively using the Modification of Diet in Renal Disease
equation. We defined “event” as new-onset stage III chronic kidney
disease (CKD) or worsening of CKD stage with preexisting CKD. Event-free
survival was assessed with Kaplan-Meier methods. Cox regression
analyses were performed to identify predictors of events.
Results
In total, 193 patients underwent RNU (n = 143) or PU (n = 50) over a median follow-up of 25.9 months. Overall, 15% of patients died of UTUC. High tumor grade (85.9% vs. 66.0%, P = 0.003) and locally advanced stage (>pT2, 37.8% vs. 18.0%, P
= 0.014) were significantly more frequent in the RNU cohort. Stage III
or higher CKD was present in 61% of RNU patients vs. 48% of PU patients (P = 0.135) at baseline. Although total event rate was higher in the PU cohort (66% vs. 43.4%, P = 0.008), event rates within the first 3 months of surgery were similar between the groups (P = 0.572). Adjuvant chemotherapy was the only predictor of events on Cox regression.
Conclusions
Rates
of new-onset CKD or worsening of CKD stage were similar in patients
treated with RNU and PU. Adjuvant chemotherapy may have a more
significant effect on renal outcomes than surgical approach, warranting
further investigation. Consideration should be given to preoperative
chemotherapy, as adjuvant chemotherapy is limited by decreased renal
function following surgery.
Keywords
- Upper tract urothelial carcinoma;
- Partial ureterectomy;
- Radical nephroureterectomy;
- Renal function
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