Prognostic Significance of Hydronephrosis in Bladder Cancer Treated by Radical Cystectomy

Abstract

Objectives: Hydronephrosis is a common finding in patients with bladder cancer. This study aims at an analysis of the association between hydronephrosis, pathologic characteristics of bladder cancer and cancer-specific survival rate after radical cystectomy. Methods: Clinical data of 241 patients who underwent radical cystectomy between 1990 and 2007 for invasive bladder cancer were analyzed retrospectively. The significance of the relation between the clinical and pathological findings were determined by the χ² test. The Kaplan-Meier test was used for the estimation of disease-specific survival obtained according to hydronephrosis, and the differences were examined by the log-rank test. Multivariate analysis was performed by the Cox regression model. Results: Of 241 patients, 39 (16.2%) had unilateral and 13 (5.4%) bilateral hydronephrosis. Five-year cancer-specific survival rates were reported as 63.4% in non-hydronephrotic and 11.57% in hydronephrotic patients (log-rank test, p < 0.001). The presence of hydronephrosis was associated with advanced pT stage, higher tumor grade and lymph node metastases (p < 0.001, p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that hydronephrosis is an important factor directly affecting cancer-specific survival (0.0264). Conclusions: The presence of hydronephrosis prior to radical cystectomy is a significant prognostic parameter, associated with poor cancer-specific survival and advanced disease stage.

Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis

“…The patient age ranged from 27 to 90.4 years, and the proportion of men was 72.5%. Of the 13 studies, 10 directly provided HR and 95% CI values [6,8,9,11–14,16–18]; one paper provided RR value [7], and one paper provided OR value [10], which were used to estimate HR (S2 Table). In addition, one article reported estimated effects and p values, but do not give CIs [15].…”

“…The combined results of the seven studies [6,8,9,12,14,16,17] were analyzed to investigate the overall association between preoperative hydronephrosis and CSS after RC. As shown in Fig 3, the combined HR and 95% CI for CSS provided in the seven studies was 1.64 (95% CI [1.33–2.02], p ≤ 0.001) with no heterogeneity among the seven studies (I 2 = 0.0%, p = 0.616) (Fig 3, fixed-effect model).…”

Australian & New Zealand Faculty of Radiation Oncology Genito‐Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder

“…In surgical 34,59 and RT series, 11,12,58 malignant hydronephrosis is an independent adverse prognostic factor in MIBC. However, it is also a marker for poor local response, 11,18 making it less likely that these patients will avoid a cystectomy following RT or CRT.…”

Association Between Preoperative Hydronephrosis and Prognosis After Radical Cystectomy Among Patients With Bladder Cancer: A Systemic Review and Meta-Analysis

“…Six studies showed a positive impact on the increased HR, but two studies showed no significant impact. Finally, merged HR to cancer-specific survival was calculated to be 1.67 (95% CI, 1.34–2.08, p < 0.00001) in 3,435 patients with bladder cancer who underwent RC (2, 3, 7, 11, 13, 14, 22, 26). Overall survival was regarded controversial according to the presence of preoperative HN.…”