Abstract
BackgroundThe outcomes of upper tract urothelial carcinoma (UTUC) receiving radical nephroureterectomy were usually limited to small sample size, case-control studies, and often focused on cancer progression. Risk of acute myocardial infarction (AMI) in these patients was never investigated.ResultsThe overall incidences of AMI were 3.39, 1.44, and 1.70 per 10,000 person-years in the radical nephroureterectomy, nonnephroureterectomy, and non-UTUC cohorts, respectively. Multivariable Cox proportional hazard regression analysis revealed a significantly higher AMI risk in the radical nephroureterectomy cohort [adjusted HR (aHR) = 1.83, 95% confidence interval (CI) = 1.08–3.11], compared with non-UTUC cohorts. The risk of mortality were the highest in patients with UTUC who had undergone radical nephroureterectomy [adjusted HR (aHR) = 5.37, 95% confidence interval (CI) = 4.80–6.02].Materials and MethodsFrom the Taiwan National Health Insurance claims data, 1,359 patients with UTUC who had undergone radical nephroureterectomy and 3,154 patients with UTUC who had undergone nephron sparing surgery and were newly diagnosed between 2000 and 2010 were identified. For each patient, 4 individuals without UTUC were randomly selected and frequency matched by age, sex, and diagnosis year.ConclusionsPatients with UTUC who have undergone radical nephroureterectomy are at a higher risk of developing AMI, compared with those receiving nephron sparing surgery.
Highlights
Despite the improvements of intervention therapy and pharmacological managements, acute myocardial infarction (AMI) remains major evens with serious consequences in increasing medical expenditure, morbidity, and mortality [1, 2]
Patients with upper tract urothelial carcinoma (UTUC) who have undergone radical nephroureterectomy are at a higher risk of developing AMI, compared with those receiving nephron sparing surgery
The cumulative incidence of AMI was much higher in patients with UTUC who had undergone radical nephroureterectomy than in those with UTUC who had undergone nephron sparing surgery and those who did not have UTUC (Figure 2A; P = 0.009)
Summary
Despite the improvements of intervention therapy and pharmacological managements, acute myocardial infarction (AMI) remains major evens with serious consequences in increasing medical expenditure, morbidity, and mortality [1, 2]. One key to success in decreasing AMI associated complications is timely www.impactjournals.com/oncotarget delivery of reperfusion therapy and fibrinolytic therapy [3]. Another most cost-effectiveness key is primary prevention which targets high-risk candidates. Several studies have investigated the outcomes of UTUC patients receiving radial nephroureterectomy versus nephron sparing surgery in order to decrease the ostoperative complications [14, 15]. Whether radical nephroureterectomy versus nephron sparing surgery would cause different outcomes of AMI and total mortality are unknown. The outcomes of upper tract urothelial carcinoma (UTUC) receiving radical nephroureterectomy were usually limited to small sample size, case-control studies, and often focused on cancer progression. Risk of acute myocardial infarction (AMI) in these patients was never investigated
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