Impact of nephroureterectomy on postoperative renal function in upper tract urothelial carcinoma: A multicenter retrospective study

Abstract

Objective To assess the impact of radical nephroureterectomy on postoperative renal function in patients with upper tract urothelial carcinoma (UTUC). Methods We retrospectively evaluated 645 patients with UTUC treated with radical nephroureterectomy between January 2000 and May 2022. The primary outcome was the rate of postoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2. Secondary outcomes included the rate of eGFR decline, identification of factors related to eGFR decline, and the impact of comorbidities (diabetes or cardiovascular disease) on postoperative eGFR at 1 year. Results The median preoperative and postoperative eGFR levels were 55.6 and 43.3 mL/min/1.73 m2, respectively. The rate of patients with preoperative and postoperative eGFR ≥60 mL/min/1.73 m2 was 40.9% and 9.0%, respectively. The median decline in eGFR after surgery was 25.1%. The presence of preoperative unilateral hydronephrosis and eGFR <60 mL/min/1.73 m2 was significantly associated with a low decline of postoperative eGFR and poor survival. The impact of the presence of comorbidities on postoperative eGFR at 1 year was significant (p < 0.001). Conclusion Impaired renal function is prevalent in patients with UTUC. The rate of patients with postoperative eGFR ≥60 mL/min/1.73 m2 was 9.0%. The presence of preoperative renal impairment was significantly related to a low decline in postoperative eGFR and poor survival. The presence of comorbidities had a significant effect on eGFR decline 1 year after radical nephroureterectomy.

Editorial Comment to Impact of nephroureterectomy on postoperative renal function in upper tract urothelial carcinoma: A multicenter retrospective study

“…Only 9.0% of the patients could maintain an eGFR of >60 mL/min/1.73 m 2 post-RNU, which was lower than those reported in studies from Western countries. 3 The level of evidence is currently stronger for the use of adjuvant chemotherapy (AC) than that for neoadjuvant chemotherapy (NAC) because of the POUT trial. 4 Furthermore, NAC is associated with better pathological downstaging and higher rates of complete response than RNU alone.…”

“…Another issue that needs to be addressed is the method to evaluate renal function as discussed by the authors. 3 A measured or a calculated creatinine clearance (CCr) of 60 mL/ min was considered as adequate renal function for cisplatin administration. However, this study, like others, utilized eGFR for the evaluation of renal function.…”

Editorial Comment to Impact of nephroureterectomy on postoperative renal function in upper tract urothelial carcinoma: A multicenter retrospective study

“…Okuyama et al investigated perioperative renal function in large-scale real-world practice. 3 Specifically, the study evaluated renal function changes before and after nephroureterectomy. It is an important fact that only 9% of patients have estimated glemerular filtration rate (eGFR) ≥60 after nephroureterectomy in clinical practice.…”

“…Okuyama et al. investigated perioperative renal function in large‐scale real‐world practice 3 . Specifically, the study evaluated renal function changes before and after nephroureterectomy.…”