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Treatment Strategy for Dialysis Patient with Urothelial Carcinoma

To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (C...

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Autores principales: Huang, Yun-Ching, Liu, Yu-Liang, Chen, Miao-Fen, Chen, Chih-Shou, Wu, Chun-Te
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624138/
https://www.ncbi.nlm.nih.gov/pubmed/34829313
http://dx.doi.org/10.3390/diagnostics11111966
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author Huang, Yun-Ching
Liu, Yu-Liang
Chen, Miao-Fen
Chen, Chih-Shou
Wu, Chun-Te
author_facet Huang, Yun-Ching
Liu, Yu-Liang
Chen, Miao-Fen
Chen, Chih-Shou
Wu, Chun-Te
author_sort Huang, Yun-Ching
collection PubMed
description To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups (p = 0.333), all 5 (4.5%) patients with Clavien–Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age (p = 0.042) and high Charlson comorbidity index (CCI) (p = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all p > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2–6.12; p = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01–4.63; p = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82–84.7; p = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC.
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spelling pubmed-86241382021-11-27 Treatment Strategy for Dialysis Patient with Urothelial Carcinoma Huang, Yun-Ching Liu, Yu-Liang Chen, Miao-Fen Chen, Chih-Shou Wu, Chun-Te Diagnostics (Basel) Article To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups (p = 0.333), all 5 (4.5%) patients with Clavien–Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age (p = 0.042) and high Charlson comorbidity index (CCI) (p = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all p > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2–6.12; p = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01–4.63; p = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82–84.7; p = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC. MDPI 2021-10-22 /pmc/articles/PMC8624138/ /pubmed/34829313 http://dx.doi.org/10.3390/diagnostics11111966 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Huang, Yun-Ching
Liu, Yu-Liang
Chen, Miao-Fen
Chen, Chih-Shou
Wu, Chun-Te
Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_full Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_fullStr Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_full_unstemmed Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_short Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
title_sort treatment strategy for dialysis patient with urothelial carcinoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624138/
https://www.ncbi.nlm.nih.gov/pubmed/34829313
http://dx.doi.org/10.3390/diagnostics11111966
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