5 years ago

Reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) at first transurethral resection of bladder tumour is a significant predictor of subsequent recurrence and progression

Tracy M. Downs, Shivashankar Damodaran, Edward M. Messing, Timothy J. Rushmer, Kyle A. Richards, E. Jason Abel, David F. Jarrard, Fangfang Shi, Victor Kucherov, Michael L. Blute
Objective To evaluate if moderate chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] is associated with high rates of non-muscle-invasive bladder cancer (NMIBC) recurrence or progression. Patients and Methods A multi-institutional database identified patients with serum creatinine values prior to first transurethral resection of bladder tumour (TURBT). The CKD-epidemiology collaboration formula calculated patient eGFR. Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS). Results In all, 727 patients were identified with a median (interquartile range [IQR]) patient age of 69.8 (60.1–77.6) years. Data for eGFR were available for 632 patients. During a median (IQR) follow-up of 3.7 (1.5–6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumour stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified an eGFR of <60 mL/min/1.73 m2 (hazard ratio [HR] 1.5, 95% confidence interval [CI]: 1.2–1.9; P = 0.002) as a predictor of tumour recurrence. The 5-year RFS rate was 46% for patients with an eGFR of ≥60 mL/min/1.73 m2 and 27% for patients with an eGFR of <60 mL/min/1.73 m2 (P < 0.001). Multivariable analysis showed that an eGFR of <60 mL/min/1.73 m2 (HR 3.7, 95% CI: 1.75–7.94; P = 0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR of ≥60 mL/min/1.73 m2 and 71% for patients with an eGFR of <60 mL/min/1.73 m2 (P = 0.01). Conclusion Moderate CKD at first TURBT is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.13904

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