Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Abstract

The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

“…The NLR, calculated as the absolute neutrophil count divided by the absolute lymphocyte count, has often been investigated as a potential indicator in various tumors [49-51]. Bladder cancer is still a challenging issue, especially the muscle-invasive and metastatic diseases, and efforts to explore and validate prognostic biomarkers for use in the personalized treatment of bladder cancer, mUC or uUC carcinoma patients are urgently required [5, 6, 52]. …”

The Impact of Preoperative Severe Renal Insufficiency on Poor Postsurgical Oncological Prognosis in Patients with Urothelial Carcinoma

“…Established predictors of prognosis include older age (>70-75 yr), tumour stage, tumour location, lymphovascular invasion (LVI), lymph node involvement [8], and mode of recurrence [9,10]. Recent evidence has suggested that preoperative renal insufficiency indicates poor prognosis in patients with MIBC and UTUC [11][12][13][14][15]. However, the impact of preoperative renal impairment severity on prognosis in urothelial carcinoma remains unelucidated.…”

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

“…Previous studies suggested kidney and urinary tract cancers are high risk for renal dysfunction due to the tumor location (obstruction, and/or reduction of nephron mass) [13,[15][16][17]. The prevalence of CKD in genitourinary cancers were reported 8.7-21.4% [15,18]. In the present study, the prevalence of CKD in MIBC patients was 37%, which is a strong bias in our cohort.…”

“…In addition, there was no significant difference between the number of CKD patients with CVD (n=35/68, 52%) and without CVD (n = 218/513, 42%) ( Figure 5E). Therefore, as previous study suggested [18], bladder cancer is great potential to have a renal dysfunction during the disease progression. Although there is no clear explanation for that, the effects of metabolic syndrome [19] and chronic inflammation may explain the association of CKD and oncological outcome [20,21].…”