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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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/11/11/1966 |
| _version_ | 1797510667858608128 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T05:34:36Z |
| format | Article |
| id | doaj.art-8c0f2d146fee4db7855ccb29336a3d5d |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T05:34:36Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-8c0f2d146fee4db7855ccb29336a3d5d2023-11-22T23:00:24ZengMDPI AGDiagnostics2075-44182021-10-011111196610.3390/diagnostics11111966Treatment Strategy for Dialysis Patient with Urothelial CarcinomaYun-Ching Huang0Yu-Liang Liu1Miao-Fen Chen2Chih-Shou Chen3Chun-Te Wu4Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, TaiwanDivision of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, TaiwanDepartment of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, TaiwanDivision of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi 613, TaiwanDepartment of Urology, Chang Gung Memorial Hospital at Keelung, Keelung 204, TaiwanTo 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.https://www.mdpi.com/2075-4418/11/11/1966urinary tractbladderneoplasmnephroureterectomycystectomydialysis |
| spellingShingle | Yun-Ching Huang Yu-Liang Liu Miao-Fen Chen Chih-Shou Chen Chun-Te Wu Treatment Strategy for Dialysis Patient with Urothelial Carcinoma Diagnostics urinary tract bladder neoplasm nephroureterectomy cystectomy dialysis |
| title | 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_short | Treatment Strategy for Dialysis Patient with Urothelial Carcinoma |
| title_sort | treatment strategy for dialysis patient with urothelial carcinoma |
| topic | urinary tract bladder neoplasm nephroureterectomy cystectomy dialysis |
| url | https://www.mdpi.com/2075-4418/11/11/1966 |
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