AUA 2017: Effect Of Radical Cystectomy And Urinary Diversion For Bladder Cancer Treatment On Renal Function Over Time
Overall, 384 patients with bladder cancer who sought care in a tertiary health care center from 2000 to 2014 were included in the study cohort. Out of these individuals, 172 had undergone RC and UD, while 212 were treated without undergoing RC and UD. Two factors were used to assess renal function decline: (a) annualized estimated glomerular filtration rate (eGFR) decline and (b) time to decrease in eGFR of 30% or more from baseline. Propensity score regression adjustment was used to address confounding by indication. Unadjusted and adjusted linear Cox proportional hazards models were used to assess the association between RC and UD, eGFR slope, and time to decrease in eGFR of 30% or more, respectively.
Mean age was 68 ± 12 years; average follow-up was 17 ± 13 months. Patients with RC and UD experienced a faster decline in renal function over time when compared with those without RC and UD. Using Cox multivariable regression models to adjust for age, propensity score, and other confounding variables, the difference in mean eGFR slope in patients with RC and UD compared with those without RC and UD, was stable and remained statistically significant (P < .001). Patients with RC and UD had a higher risk of eGFR decline of 30% or more compared with those without RC and UD (unadjusted hazard ratio = 1.88, 95% confidence interval: 1.35-2.63; P < .001); this persisted despite adjustment for age but was attenuated and no longer statistically significant after adjustment for propensity score and confounding variables (adjusted hazard ratio = 1.01, 95% confidence interval: 0.62-1.63; P = .976).
In conclusion, RC and UD were independently associated with a faster decline in renal function over time and also linked with a higher risk of eGFR decline of 30% or more only in the unadjusted analysis. These results add to the growing body of knowledge on the relationship between renal function decline and RC, thereby helping to formulate intervention strategies to prevent renal function deterioration in this population.
Presented By: Shahab Bozorgmehri, MD, PhD, Gainesville, FL
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA