Abstract:
Objective To observe the effect of preoperative hydronephrosis on the prognosis and survival of patients with different tumor–node–metastasis (TNM) stages of bladder cancer after radical cystectomy.
Methods The clinical data of 231 patients undergoing radical cystectomy at The Second Affiliated Hospital of Kunming Medical University between January 2013 and December 2017 were retrospectively analyzed. According to the preoperative presence of hydronephrosis, the patients were assigned into groups with hydronephrosis (n=96) and without hydronephrosis (n=135), and the overall survival (OS) of the two groups was compared. Univariate and multivariate analyses of prognostic factors were performed using Cox proportional risk regression. Additionally, the patients were assigned into groups according to different TNM stages. Survival curves were drawn using the Kaplan-Meier method, and significance analysis was performed using the Log-rank test.
Results The 3-year and 5-year OS of patients with hydronephrosis were 62.5%±4.9% and 38.5%±5%, respectively, and the 3-year and 5-year OS of patients without hydronephrosis were 74.8%±3.7% and 66.8%±4.1%, respectively-these were significantly higher than those of patients with hydronephrosis (P<0.001). Multivariate Cox proportional risk regression analysis showed that preoperative hydronephrosis, T stage, and lymph node metastasis were independent factors influencing postoperative OS. According to the stratified analysis on the different TNM stages, there was no significant difference in survival between the T2N0M0 group with hydronephrosis and T3–4N0M0 group without hydronephrosis (P=0.816), and between the T3–4N0M0 group with hydronephrosis and TxN+Mx group without hydronephrosis (P=0.591).
Conclusions Preoperative hydronephrosis was an independent factor influencing OS after radical cystectomy. Subsequently, preoperative hydronephrosis can shift the postoperative survival curve of patients with cancer stages T2N0M0 and T3–4N0M0 to a later pathological stage.
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