MP77-03 DIABETES MELLITUS INCREASES BLADDER CANCER RECURRENCE RISK IN PATIENTS WITH UPPER URINARY TRACT UROTHELIAL CARCINOMA

Abstract

INTRODUCTION AND OBJECTIVES: Diabetes mellitus (DM) is a common health problem and a risk factor for developing bladder cancer. However, there are few data regarding the relationship between DM and the clinical outcome of upper urinary tract urothelial carcinoma (UUC). In this study, we investigated the association of DM and bladder cancer recurrence following nephroureterectomies (NU) in UUC patients. METHODS: Between January 1996 and March 2011, 349 UUC patients who received NU and bladder cuff resections were enrolled in this study. The associations between metachronous bladder cancer recurrence and clinicopathologic characteristics of the UUC patients were analyzed using the Cox proportional hazards model. Patients with bladder cancer before or at UUC diagnosis were excluded from analysis. RESULTS: In the UUC cohort, DM was diagnosed in 65 patients (18.6%). The diabetic patients were elderly and more likely to have hypertension as compared with non-diabetic patients. There was no significant difference in tumor grade, stage, or location; smoking status; or dialysis status. During the median follow-up duration of 27 months, there was bladder cancer recurrence in 41.5% and 28.2% of diabetic and non-diabetic UUC patients, respectively. The 5-year bladder cancer recurrenceiVfree survival rates were 49% and 60% in diabetic and non-diabetic patients, respectively. Furthermore, 17 poorly controlled diabetes patients (Hemoglobin A1c [HbA1c] 7.0%) exhibited a significantly higher rate of subsequent bladder cancer recurrence (70.6% vs. 16.7%, p 1⁄4 0.001) as compared with 18 well-controlled diabetes patients (HbA1c < 7.0%). In multivariate analysis, ureteral tumor (HR 1⁄4 1.85, p 1⁄4 0.002), diabetes (HR 1⁄4 1.615, p 1⁄4 0.035), and dialysis (HR 1⁄4 2.067, p 1⁄4 0.007) were independent risk factors for metachronous bladder cancer recurrence after NU. CONCLUSIONS: DM is an independent risk factor for bladder cancer recurrence in UUC patients treated with NU. In addition, poor control of diabetes (HbA1c 7.0%) was significantly associated with a high risk of subsequent bladder cancer recurrence. These results underscore the need for intensive glycemic control and close follow-up.