The significance of preoperative estimated glomerular filtration rate on survival outcomes in patients who underwent radical cystectomy and non-continent urinary diversion

ABSTRACT Purpose To evaluate the influence of preoperative renal function on survival outcomes in patients who underwent radical cystectomy (RC) with non-continent urinary diversion (UD). Materials and Methods A total of 132 patients with bladder cancer who underwent RC with non-continent UD due to urothelial carcinoma from January 2006 toMarch 2017 at our tertiary referral center were retrospectively evaluated. Patients were divided into 2 groups as those with estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2 and ≥60mL/min/1.73 m2 according to preoperative eGFR levels. Patients’ characteristics, preoperative clinical data, operative data, pathologic data, oncologic data and complications were compared between the groups. Results The mean age was 64.5±8.7 (range: 32 - 83) years and the median follow-up was 30.9±31.7 (range: 1-113) months. There were 46 patients in Group 1 and 86 patients in Group 2. There was no difference in cancer-specific mortality (45.6% for group 1 and 30.2% for group 2, p=0.078) and survival (56.8±8.3 months for group 1 and 70.5±5.9 months for group 2, p=0.087) between the groups. Overall mortality was higher (63% for group 1 and 40.7% for group 2, p=0.014) and overall survival (43.6±6.9 months for group 1 and 62.2±5.8 months for group 2, p=0.03) was lower in Group 1 compared to Group 2. Conclusions Overall mortality was higher and overall survival was lower in patients with preoperative eGFR <60mL/s. More patients had preoperative hydronephrosis with eGFR< 60mL/s.

摘要
研究目的：评估术前肾功能对接受根治性膀胱切除术（radical cystectomy, RC）联合非控尿尿路改道（non-continent urinary diversion, UD）的膀胱癌患者生存结局的影响。
材料与方法：回顾性分析2006年1月至2017年3月于本三级转诊中心因尿路上皮癌接受RC联合非控尿尿路改道的132例膀胱癌患者。根据术前估算肾小球滤过率（estimated glomerular filtration rate, eGFR）水平将患者分为两组：eGFR<60mL/min/1.73m²组与eGFR≥60mL/min/1.73m²组。比较两组患者的基线特征、术前临床资料、手术资料、病理资料、肿瘤学资料及并发症发生情况。
结果：本研究纳入患者的平均年龄为64.5±8.7岁（范围：32~83岁），中位随访时间为30.9±31.7个月（范围：1~113个月）。其中组1（eGFR<60mL/min/1.73m²）46例，组2（eGFR≥60mL/min/1.73m²）86例。两组患者的癌症特异性死亡率（组1为45.6%，组2为30.2%，p=0.078）与生存率（组1为56.8±8.3个月，组2为70.5±5.9个月，p=0.087）差异均无统计学意义。与组2相比，组1患者的总死亡率更高（组1为63%，组2为40.7%，p=0.014），总生存期更短（组1为43.6±6.9个月，组2为62.2±5.8个月，p=0.03）。
结论：术前eGFR<60mL/min/1.73m²的患者总死亡率更高、总生存期更短，且该类患者术前肾积水发生率更高。