The impact of post-nephroureterectomy surgically induced chronic kidney disease on survival outcomes.

• Tác giả: Firas Abdollah, Daniele Amparore, Alessandro Antonelli, Riccardo Autorino, Raj Bhanvadia, Stephan Broenimann, Andreas Correa, Ithaar H Derweesh, Francesco Ditonno, Hooman Djaladat, Benjamine M Eilender, Matteo Ferro, Marco Finati, Antonio Franco, Alireza Ghoreifi, Mark L Gonzalgo, Emma Helstrom, Vitaly Margulis, Margaret F Meagher, Reza Mehrazin, Dinno F Mendiola, Sol C Moon, Sisto Perdonà, Francesco Porpiglia, Dhruv Puri, Soroush Rais-Bahrami, Giuseppe Simone, Nirmish Singla, Chandru P Sundaram, Marco Tozzi, Gabriele Tuderti, Antonio Tufano, Linhui Wang, Zhenjie Wu, Courtney Yong
• Ngôn ngữ: eng
• Thông tin xuất bản: England : BJU international , 2025
• Bộ sưu tập: NCBI
• ID: 220367

Tóm tắt

 OBJECTIVE: To investigate the prevalence, predictors and impact of surgically induced chronic kidney disease (CKD-S) on survival outcomes in patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). METHODS: Utilising the ROBUUST 2.0 registry, a multicentre retrospective analysis was conducted in patients with UTUC undergoing RNU between 2006 and 2022 who did not have baseline chronic kidney disease (CKD) stages 3-5. We calculated the prevalence of postoperative CKD-S3a (estimated glomerular filtration rate [eGFR] 59-45 mL/min/1.73 m RESULTS: We analysed 1862 patients
  34.7% (646) and 39.6% (738), respectively, developed CKD-S3a and CKD-S3b. Predictors of CKD-S3b included increasing age (odds ratio [OR] 1.03, P = 0.029), decreasing preoperative eGFR (OR 1.06, P <
  0.001) and receipt of neoadjuvant (OR 2.07, P = 0.006) and adjuvant chemotherapy (OR 1.41, P = 0.012). Worsened ACM was associated with CKD-S3b (hazard ratio 1.42, P = 0.032), but not CKD-S3a (P = 0.766). Development of CKD-S3a (P = 0.812) and CKD-S3b (P = 0.316) were not associated with CSM. The 5-year OS rate was significantly worse in CKD-S3b (no-CKD 71%, CKD-S3a 70%, CKD-S3b 59%
  P = 0.017). No differences between CKD-S groups were noted for 5-year CSS (no-CKD 78%, CKD-S3a 77%, CKD-S3b 82%
  P = 0.44). CONCLUSIONS: A significant proportion of UTUC patients undergoing RNU developed CKD-S. Development of CKD-S3b was associated with worse ACM. Increasing age, preoperative eGFR, and chemotherapy were associated with developing CKD-S3b. Our findings call for further exploration and refinement of nephron-preserving surgical strategies and non-nephrotoxic systemic therapy to improve survival outcomes in UTUC.