Prognostic impact of preoperative renal function in patients treated with radical cystectomy: a multi-institutional retrospective study.

Abstract

Little data on the preoperative prognostic factors in radical cystectomy (RC) patients have made it difficult to choose the appropriate type of urothelial diversion (UD). This study aimed to investigate the prognostic role of UD, with a subgroup analysis of that of preoperative renal function. From 1990 to 2015, 279 patients underwent RC for bladder cancer at six hospitals affiliated with Kitasato University in Japan. All patients were divided into three groups: cutaneous ureterostomy (CU; n = 54), ileal conduit (IC; n = 139), and orthotopic neobladder (NB; n = 86). Patients were also stratified into three groups based on preoperative estimated glomerular filtration rate (eGFR) (mL/min/1.73m2): normal eGFR (> 60mL/min/1.73m2; n = 149), moderately reduced eGFR (45-60mL/min/1.73m2; n = 66), and severely reduced eGFR (< 45mL/min/1.73m2; n = 37). Statistical analyses were performed to investigate prognostic values of UD and preoperative eGFR. Kaplan-Meier analyses showed that progression-free survival (PFS) and cancer-specific survival (CSS) did not differ between the three types of UD groups. With regard to renal function, the preoperative severely reduced group had significantly worse PFS and CSS than the other groups. The multivariate analysis showed that severely reduced preoperative eGFR was an independent risk factor of worse PFS and worse CSS. The present study demonstrated that preoperative severe renal function was shown as an independent risk factor of both PFS and CSS.