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Authors Blute ML, Kucherov V, Rushmer TJ, Damodaran S, Shi F, Abel EJ, Jarrard DF, Richards KA, Messing EM, Downs TM
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Journal BJU Int. Volume: 120 Issue: 3 Pages: 387-393
Publish Date 2017 Sep
PubMed ID 28464520
Abstract

To evaluate if moderate chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) ] is associated with high rates of non-muscle-invasive bladder cancer (NMIBC) recurrence or progression.A multi-institutional database identified patients with serum creatinine values prior to first transurethral resection of bladder tumour (TURBT). The CKD-epidemiology collaboration formula calculated patient eGFR. Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS).In all, 727 patients were identified with a median (interquartile range [IQR]) patient age of 69.8 (60.1-77.6) years. Data for eGFR were available for 632 patients. During a median (IQR) follow-up of 3.7 (1.5-6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumour stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified an eGFR of <60 mL/min/1.73 m(2) (hazard ratio [HR] 1.5, 95% confidence interval [CI]: 1.2-1.9; P = 0.002) as a predictor of tumour recurrence. The 5-year RFS rate was 46% for patients with an eGFR of ≥60 mL/min/1.73 m(2) and 27% for patients with an eGFR of <60 mL/min/1.73 m(2) (P < 0.001). Multivariable analysis showed that an eGFR of <60 mL/min/1.73 m(2) (HR 3.7, 95% CI: 1.75-7.94; P = 0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR of ≥60 mL/min/1.73 m(2) and 71% for patients with an eGFR of <60 mL/min/1.73 m(2) (P = 0.01).Moderate CKD at first TURBT is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance.


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