Treatment Strategy for Dialysis Patient with Urothelial Carcinoma

To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (C...

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Autores principales:	Yun-Ching Huang, Yu-Liang Liu, Miao-Fen Chen, Chih-Shou Chen, Chun-Te Wu
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	urinary tract bladder neoplasm nephroureterectomy cystectomy dialysis Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/8c0f2d146fee4db7855ccb29336a3d5d
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spelling	oai:doaj.org-article:8c0f2d146fee4db7855ccb29336a3d5d2021-11-25T17:20:19ZTreatment Strategy for Dialysis Patient with Urothelial Carcinoma10.3390/diagnostics111119662075-4418https://doaj.org/article/8c0f2d146fee4db7855ccb29336a3d5d2021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/1966https://doaj.org/toc/2075-4418To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups (<i>p</i> = 0.333), all 5 (4.5%) patients with Clavien–Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age (<i>p</i> = 0.042) and high Charlson comorbidity index (CCI) (<i>p</i> = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all <i>p</i> > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2–6.12; <i>p</i> = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01–4.63; <i>p</i> = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82–84.7; <i>p</i> = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC.Yun-Ching HuangYu-Liang LiuMiao-Fen ChenChih-Shou ChenChun-Te WuMDPI AGarticleurinary tractbladderneoplasmnephroureterectomycystectomydialysisMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 1966, p 1966 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	urinary tract bladder neoplasm nephroureterectomy cystectomy dialysis Medicine (General) R5-920
spellingShingle	urinary tract bladder neoplasm nephroureterectomy cystectomy dialysis Medicine (General) R5-920 Yun-Ching Huang Yu-Liang Liu Miao-Fen Chen Chih-Shou Chen Chun-Te Wu Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
description	To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups (<i>p</i> = 0.333), all 5 (4.5%) patients with Clavien–Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age (<i>p</i> = 0.042) and high Charlson comorbidity index (CCI) (<i>p</i> = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all <i>p</i> > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2–6.12; <i>p</i> = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01–4.63; <i>p</i> = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82–84.7; <i>p</i> = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC.
format	article
author	Yun-Ching Huang Yu-Liang Liu Miao-Fen Chen Chih-Shou Chen Chun-Te Wu
author_facet	Yun-Ching Huang Yu-Liang Liu Miao-Fen Chen Chih-Shou Chen Chun-Te Wu
author_sort	Yun-Ching Huang
title	Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_short	Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_full	Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_fullStr	Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_full_unstemmed	Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_sort	treatment strategy for dialysis patient with urothelial carcinoma
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/8c0f2d146fee4db7855ccb29336a3d5d
work_keys_str_mv	AT yunchinghuang treatmentstrategyfordialysispatientwithurothelialcarcinoma AT yuliangliu treatmentstrategyfordialysispatientwithurothelialcarcinoma AT miaofenchen treatmentstrategyfordialysispatientwithurothelialcarcinoma AT chihshouchen treatmentstrategyfordialysispatientwithurothelialcarcinoma AT chuntewu treatmentstrategyfordialysispatientwithurothelialcarcinoma
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Treatment Strategy for Dialysis Patient with Urothelial Carcinoma

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