Treatment Strategy for Dialysis Patient with Urothelial Carcinoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Pathological Examination
2.3. Postoperative Follow-Up
2.4. Outcome Measures
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. Pathologic Features
3.3. Perioperative Complications
3.4. Predictive Probability of Major Complication and Mortality
3.5. Survival and Recurrence
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Butler, A.M.; Olshan, A.F.; Kshirsagar, A.V.; Edwards, J.; Nielsen, M.E.; Wheeler, S.B.; Brookhart, M.A. Cancer incidence among US medicare ESRD patients receiving hemodialysis, 1996–2009. Am. J. Kidney Dis. 2015, 65, 763–772. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chang, C.-H.; Yang, C.-M.; Yang, A.-H. Renal diagnosis of chronic hemodialysis patients with urinary tract transitional cell carcinoma in Taiwan. Cancer 2007, 109, 1487–1492. [Google Scholar] [CrossRef] [PubMed]
- Nortier, J.L.; Martinez, M.-C.M.; Schmeiser, H.H.; Arlt, V.M.; Bieler, C.A.; Petein, M.; Depierreux, M.F.; de Pauw, L.; Abramowicz, D.; Vereerstraeten, P.; et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N. Engl. J. Med. 2000, 342, 1686–1692. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chiou, H.Y.; Chiou, S.-T.; Hsu, Y.-H.; Chou, Y.-L.; Tseng, C.-H.; Wei, M.-L.; Chen, C.-J. Incidence of transitional cell carcinoma and arsenic in drinking water: A follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. Am. J. Epidemiol. 2001, 153, 411–418. [Google Scholar] [CrossRef] [PubMed]
- Gonwa, T.A.; Corbett, W.T.; Schey, H.M.; Buckalew, V.M. Analgesic-associated nephropathy and transitional cell carcinoma of the urinary tract. Ann. Intern. Med. 1980, 93, 249. [Google Scholar] [CrossRef] [PubMed]
- Hortlund, M.; Mühr, L.S.A.; Storm, H.; Engholm, G.; Dillner, J.; Bzhalava, D. Cancer risks after solid organ transplantation and after long-term dialysis. Int. J. Cancer 2017, 140, 1091–1101. [Google Scholar] [CrossRef]
- Ou, J.-H.; Pan, C.-C.; Lin, J.S.-N.; Tzai, T.-S.; Yang, W.-H.; Chang, C.-C.; Cheng, H.-L.; Lin, Y.-M.; Tong, Y.-C. Transitional cell carcinoma in dialysis patients. Eur. Urol. 2000, 37, 90–94. [Google Scholar] [CrossRef]
- Wang, T.-Y.; Hu, C.-J.; Kuo, C.-W.; Chen, Y.; Lin, J.-L.; Yang, C.-W.; Yen, T.-H. High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end-stage renal disease. Nephrology 2011, 16, 225–231. [Google Scholar] [CrossRef]
- Wu, C.-F.; Shee, J.-J.; Ho, D.-R.; Chen, W.-C.; Chen, C.-S. Different treatment strategies for end stage renal disease in patients with transitional cell carcinoma. J. Urol. 2004, 171, 126–129. [Google Scholar] [CrossRef]
- Wu, C.-F.; Chang, P.-L.; Chen, C.-S.; Chuang, C.-K.; Weng, H.-H.; Pang, S.-T. The outcome of patients on dialysis with upper urinary tract transitional cell carcinoma. J. Urol. 2006, 176, 477–481. [Google Scholar] [CrossRef]
- Yossepowitch, O.; Sagy, I.; Margel, D.; Baniel, J. Urothelial carcinoma of the bladder in patients on hemodialysis: Clinical characteristics and oncological outcomes. J. Urol. 2012, 187, 1215–1219. [Google Scholar] [CrossRef]
- Sato, Y.; Kondo, T.; Takagi, T.; Junpei, I.; Tanabe, K. Treatment strategy for bladder cancer in patients on hemodialysis: A clinical review of 28 cases. Int. Urol. Nephrol. 2016, 48, 503–509. [Google Scholar] [CrossRef]
- Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004, 240, 205–213. [Google Scholar] [CrossRef]
- Gakis, G.; Efstathiou, J.; Lerner, S.P.; Cookson, M.S.; Keegan, K.A.; Guru, K.A.; Shipley, W.U.; Heidenreich, A.; Schoenberg, M.P.; Sagaloswky, A.I.; et al. ICUD-EAU international consultation on bladder cancer 2012: Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur. Urol. 2013, 63, 45–57. [Google Scholar] [CrossRef]
- Huang, Y.-C.; Chang, Y.-H.; Shindel, A.W.; Lin, J.-H.; Ho, D.-R.; Chen, C.-S.; Chang, Y.-L. Perioperative complications and mortality in patients with urothelial carcinoma and end-stage renal disease undergoing one-stage complete urinary tract extirpation. Ann. Surg. Oncol. 2017, 25, 573–581. [Google Scholar] [CrossRef]
- Yuh, B.E.; Nazmy, M.; Ruel, N.H.; Jankowski, J.T.; Menchaca, A.R.; Torrey, R.R.; Linehan, J.A.; Lau, C.S.; Chan, K.G.; Wilson, T.G. Standardized analysis of frequency and severity of complications after robot-assisted radical cystectomy. Eur. Urol. 2012, 62, 806–813. [Google Scholar] [CrossRef]
- Huang, Y.-C. ASO author reflections: Complications in urinary tract extirpation. Ann. Surg. Oncol. 2018, 25, 976–977. [Google Scholar] [CrossRef] [PubMed]
- Huang, Y.-C.; Chen, M.-F.; Shi, C.-S.; Shindel, A.W.; Huang, C.-E.; Pang, S.-T.; Chen, C.-S.; Chang, Y.-H.; Lin, W.-Y.; Ho, D.-R.; et al. The efficacy of postoperative adjuvant chemotherapy for patients with pT3N0M0 upper tract urothelial carcinoma. J. Urol. 2015, 194, 323–330. [Google Scholar] [CrossRef] [PubMed]
- Wu, C.-F.; Pang, S.-T.; Chen, C.-S.; Chuang, C.-K.; Chen, Y.; Lin, P.-Y. The impact factors on prognosis of patients with pT3 upper urinary tract transitional cell carcinoma. J. Urol. 2007, 178, 446–450. [Google Scholar] [CrossRef] [PubMed]
- Huang, Y.-C.; Chang, Y.-H.; Chiu, K.-H.; Shindel, A.W.; Lai, C.-H. Adjuvant radiotherapy for locally advanced upper tract urothelial carcinoma. Sci. Rep. 2016, 6, 38175. [Google Scholar] [CrossRef] [Green Version]
- Tseng, S.-F.; Chuang, Y.-C.; Yang, W.-C. Long-term outcome of radical cystectomy in ESDR patients with bladder urothelial carcinoma. Int. Urol. Nephrol. 2011, 43, 1067–1071. [Google Scholar] [CrossRef]
- Ou, C.-H.; Yang, W.-H. Long-term outcomes of complete urinary tract exenteration for dialysis patients with urothelial cancer. Int. Urol. Nephrol. 2017, 49, 623–627. [Google Scholar] [CrossRef]
- Fang, D.; Liu, P.; Liqun, Z.; Xiong, G.; Zhang, L.; Singla, N.; Zhao, G.; He, Q.; He, Z.; Zhou, L. Characteristics and treatment outcomes of pan-urothelial cell carcinoma: A descriptive analysis of 45 patients. Sci. Rep. 2015, 5, 18014. [Google Scholar] [CrossRef] [Green Version]
- Holton, M.R.; van Zijl, P.S.; Oberle, W.T.; Jacobs, S.C.; Sklar, G.N. Complete urinary tract extirpation: The University of Maryland experience. Urology 2006, 68, 65–69. [Google Scholar] [CrossRef]
- Kang, C.-H.; Chen, C.-H.; Chiang, P.-H. Primary urothelial carcinoma of the upper urinary tract in dialysis patients with 5-year follow-up. Jpn. J. Clin. Oncol. 2009, 40, 241–246. [Google Scholar] [CrossRef] [Green Version]
- Bada, M.; de Concilio, B.; Crocetto, F.; Creta, M.; Silvestri, T.; di Mauro, M.; Celia, A. Laparoscopic radical cystectomy with extracorporeal urinary diversion: An Italian single-center experience with 10-year outcomes. Minerva Urol. Nefrol. 2020, 72, 641–643. [Google Scholar] [CrossRef]
- Burger, M.; Catto, J.; Dalbagni, G.; Grossman, H.B.; Herr, H.; Karakiewicz, P.; Kassouf, W.; Kiemeney, L.; la Vecchia, C.; Shariat, S.; et al. Epidemiology and risk factors of urothelial bladder cancer. Eur. Urol. 2013, 63, 234–241. [Google Scholar] [CrossRef]
- Munoz, J.J.; Ellison, L.M. Upper tract urothelial neoplasms: Incidence and survival during the last 2 decades. J. Urol. 2000, 164, 1523–1525. [Google Scholar] [CrossRef]
- Wang, S.-M.; Lai, M.-N.; Wei, A.; Chen, Y.-Y.; Pu, Y.-S.; Chen, P.-C.; Wang, J.-D. Increased risk of urinary tract cancer in ESRD patients associated with usage of chinese herbal products suspected of containing aristolochic acid. PLoS ONE 2014, 9, e105218. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hsieh, S.-C.; Lin, I.-H.; Tseng, W.-L.; Lee, C.-H.; Wang, J.-D. Prescription profile of potentially aristolochic acid containing Chinese herbal products: An analysis of National Health Insurance data in Taiwan between 1997 and 2003. Chin. Med. 2008, 3, 13. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yang, W.C.; Hwang, S.J. Taiwan Society of Nephrology. Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: The impact of national health insurance. Nephrol. Dial. Transpl. 2008, 23, 3977–3982. [Google Scholar] [CrossRef] [Green Version]
- Donat, S.M. Standards for surgical complication reporting in urologic oncology: Time for a change. Urology 2007, 69, 221–225. [Google Scholar] [CrossRef]
- Shabsigh, A.; Korets, R.; Vora, K.C.; Brooks, C.M.; Cronin, A.M.; Savage, C.; Raj, G.; Bochner, B.; Dalbagni, G.; Herr, H.W.; et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur. Urol. 2009, 55, 164–176. [Google Scholar] [CrossRef] [PubMed]
- Miskulin, D. Characterizing comorbidity in dialysis patients: Principles of measurement and applications in risk adjustment and patient care. Perit. Dial. Int. 2005, 25, 320–332. [Google Scholar] [CrossRef] [PubMed]
- Saran, R.; Robinson, B.; Abbott, K.C.; Bragg-Gresham, J.; Chen, X.; Gipson, D.; Gu, H.; Hirth, R.A.; Hutton, D.; Jin, Y.; et al. US renal data system 2019 annual data report: Epidemiology of kidney disease in the United States. Am. J. Kidney Dis. 2019, 75, A6–A7. [Google Scholar] [CrossRef]
- Collins, A.J.; Foley, R.N.; Herzog, C.; Chavers, B.M.; Gilbertson, D.; Ishani, A.; Kasiske, B.L.; Liu, J.; Mau, L.-W.; McBean, M.; et al. Excerpts from the US renal data system 2009 annual data report. Am. J. Kidney Dis. 2010, 55, A6–A7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Noh, J.; Yoo, K.D.; Bae, W.; Lee, J.S.; Kim, K.; Cho, J.-H.; Lee, H.; Kim, D.K.; Lim, C.S.; Kang, S.-W.; et al. Prediction of the mortality risk in peritoneal dialysis patients using machine learning models: A nation-wide prospective cohort in Korea. Sci. Rep. 2020, 10, 7470. [Google Scholar] [CrossRef]
- Chang, S.S.; Bochner, B.H.; Chou, R.; Dreicer, R.; Kamat, A.M.; Lerner, S.P.; Lotan, Y.; Meeks, J.J.; Michalski, J.M.; Morgan, T.M.; et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J. Urol. 2017, 198, 552–559. [Google Scholar] [CrossRef]
- Witjes, J.A.; Bruins, H.M.; Cathomas, R.; Compérat, E.M.; Cowan, N.C.; Gakis, G.; Hernández, V.; Espinós, E.L.; Lorch, A.; Neuzillet, Y.; et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: Summary of the 2020 guidelines. Eur. Urol. 2021, 79, 82–104. [Google Scholar] [CrossRef]
- Ferro, M.; Caputo, V.F.; Barone, B.; Imbimbo, C.; de Cobelli, O.; Crocetto, F. Lymphocyte to monocyte ratio: A new independent prognostic factor in bladder cancer progression? Front. Oncol. 2021, 11, 754649. [Google Scholar] [CrossRef]
Features | Total (n = 111) | One-Stage CUTE (n = 84) | Multiple-Stage CUTE (n = 27) | p Value |
---|---|---|---|---|
Gender Female, n (%) Male, n (%) | 69 (62.2) 42 (37.8) | 52 (61.9) 32 (38.1) | 17 (63.0) 10 (37.0) | 1.000 |
Age, years, median (range) | 62.0 (23.6–83.4) | 62.0 (23.6–83.4) | 60.6 (28.0–75.1) | 0.315 |
Current smoking, n (%) | 9 (8.1) | 7 (8.3) | 2 (7.4) | 1.000 |
BMI, kg/m2, median (range) | 22.5 (16.2–38.1) | 22.4 (16.2–38.1) | 23.6 (17.6–33.2) | 0.233 |
Renal replacement therapy a Peritoneal dialysis, n (%) Hemodialysis, n (%) | 12 (11.4) 93 (88.6) | 8 (10.1) 71 (89.9) | 4 (15.4) 22 (84.6) | 0.486 |
Abdominal surgery history, n (%) | 36 (32.4) | 24 (28.6) | 12 (44.4) | 0.157 |
CCI, median (range) ≤4, n (%) ≥5, n (%) | 4 (3–9) 57 (51.4) 54 (48.6) | 4 (3–9) 43 (51.2) 41 (48.8) | 4 (4–9) 14 (51.9) 13 (48.1) | 0.750 1.000 |
ASA score 2, n (%) 3, n (%) Unknown, n (%) | 8 (7.2) 99 (89.2) 4 (3.6) | 4 (4.8) 80 (95.2) 0 (0) | 4 (14.8) 19 (70.4) 4 (14.8) | 0.063 |
Operative methods Laparoscopic, n (%) Open, n (%) | 36 (32.4) 75 (67.6) | 28 (33.3) 56 (66.7) | 8 (29.6) 19 (70.4) | 0.816 |
Adjuvant therapy, n (%) b | 17 (15.3) | 11 (13.1) | 6 (22.2) | 0.355 |
Tumor Location and Stage | Total (n = 111) | One-Stage CUTE (n = 84) | Multiple-Stage CUTE (n = 27) | p Value |
---|---|---|---|---|
Tumor location a Unilateral upper urinary tract Bladder Bilateral upper urinary tract Unilateral upper urinary tract + bladder Bilateral upper urinary tract + bladder No residual tumor b | 14 (12.6) 17 (15.3) 21 (18.9) 19 (17.1) 33 (29.7) 7 (6.3) | 11 (13.1) 15 (17.9) 14 (16.7) 16 (19.0) 21 (25.0) 7 (8.3) | 3 (11.1) 2 (7.4) 7 (25.9) 3 (11.1) 12 (44.4) 0 (0) | 0.154 |
Upper urinary tract highest stage a 0a/0is I II III IV No tumor | 30 (27.0) 22 (19.8) 13 (11.7) 13 (11.7) 9 (8.1) 24 (21.6) | 23 (27.4) 17 (20.2) 8 (9.5) 8 (9.5) 6 (7.1) 22 (26.2) | 7 (25.9) 5 (18.5) 5 (18.5) 5 (18.5) 3 (11.1) 2 (7.4) | 0.252 |
Bladder stage a 0a/0is I II III IV No residual tumor | 19 (17.1) 29 (26.1) 10 (9.0) 7 (6.3) 4 (3.6) 42 (37.8) | 15 (17.9) 23 (27.4) 6 (7.1) 5 (6.0) 3 (3.6) 32 (38.1) | 4 (14.8) 6 (22.2) 4 (14.8) 2 (7.4) 1 (3.7) 10 (37.0) | 0.885 |
Tumor grade b Low High | 5 (4.8) 99 (95.2) | 4 (5.2) 73 (94.8) | 1 (3.7) 26 (96.3) | 1.000 |
Lymphovascular invasion | 14 (12.6) | 9 (10.7) | 5 (18.5) | 0.322 |
Carcinoma in situ | 20 (18.0) | 14 (16.7) | 6 (22.2) | 0.568 |
Positive surgical margin | 5 (4.5) | 3 (3.6) | 2 (7.4) | 0.594 |
Grading | Total (n = 111) | One-Stage CUTE (n = 84) | Multiple-Stage CUTE (n = 27) | p Value |
---|---|---|---|---|
Grade 0 | 17 (15.3) | 15 (17.9) | 2 (7.4) | 0.235 |
Grade 1 | 18 (16.2) | 17 (20.2) | 1 (3.7) | 0.068 |
Grade 2 | 36 (32.4) | 22 (26.2) | 14 (51.9) | 0.018 |
Grade 3 Surgical intervention Arteriovenous shunt dysfunction Wound dehiscence Rectovaginal or vaginal fistula Spleen laceration or splenectomy Rectal perforation Vaginal bleeding Enterolysis Intra-abdominal abscess Radiological intervention Endoscopic intervention | 30 (27.0) 23 (20.7) 12 (10.8) 3 (2.7) 2 (1.8) 2 (1.8) 1 (0.9) 1 (0.9) 1 (0.9) 1 (0.9) 5 (4.5) 2 (1.8) | 21 (25.0) 17 (16.7) 9 (10.7) 1 (1.2) 2 (2.4) 2 (2.4) 1 (1.2) 1 (1.2) 1 (1.2) 3 (3.6) 1 (1.2) | 9 (33.3) 6 (22.2) 3 (11.1) 2 (7.4) 1 (3.7) 2 (7.4) 1 (3.7) | 0.457 |
Grade 4, life-threatening organ dysfunction | 5 (4.5) | 4 (4.8) | 1 (3.7) | 1.000 |
Grade 5, death | 5 (4.5) | 5 (6.0) | 0 (0) | 0.333 |
Major Complication | Mortality | |||||||
---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | |||||
OR (95% CI) | p Value | OR (95% CI) | p Value | OR (95% CI) | p Value | OR (95% CI) | p Value | |
Female gender (referent: male) | 1.43 (0.64–3.24) | 0.385 | 0.39 (0.06–2.43) | 0.311 | ||||
Age (referent: <60 years) 60–70 >70 | 1.46 (0.55–3.92) 3.82 (1.47–9.97) | 0.021 (0.451) (0.006) | 1.73 (0.60–4.99) 3.72 (1.34–10.4) | 0.042 (0.308) (0.012) | 10,000 (0–10,000) 10,000 (0–10,000) | 0.429 (0.997) (0.997) | ||
BMI ≥ 25 kg/m2 (referent: <25 kg/m2) | 1.53 (0.40–4.63) | 0.365 | 0.99 (0.10–9.92) | 0.991 | ||||
Renal replacement therapy (referent: hemodialysis) | 1.36 (0.17–2.26) | 0.621 | 0 (0–10,000) | 0.999 | ||||
Prior abdominal surgery (referent: absent) | 1.20 (0.53–2.73) | 0.665 | 0 (0–10,000) | 0.998 | ||||
CCI (referent: ≤4) | 4.85 (2.08–11.3) | 0.000 | 4.78 (1.98–11.5) | 0.000 | 4.48 (0.49–41.4) | 0.186 | ||
ASA score 3 (referent: ASA 2) | 1.79 (0.34–9.33) | 0.489 | 10,000 (0–10,000) | 0.999 | ||||
Operative methods (referent: laparoscopy) | 2.11 (0.87–5.11) | 0.097 | 1.97 (0.21–18.3) | 0.550 |
Overall Survival | Cancer-Specific Survival | Recurrence-Free Survival | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | Univariate | Multivariate | |||||||
Variables | HR (95%CI) | p Value | HR (95%CI) | p Value | HR (95%CI) | p Value | HR (95%CI) | p Value | HR (95%CI) | p Value | HR (95%CI) | p Value |
Female gender (referent: male) | 0.52 (0.27–1.03) | 0.061 | 0.42 (0.08–2.13) | 0.296 | 0.32 (0.10–0.98) | 0.046 | 0.40 (0.10–1.59) | 0.191 | ||||
Age (referent: < 60 years) 60–70 >70 | 1.05 (0.40–2.78) 3.87 (1.79–8.36) | 0.001 (0.922) (0.001) | 1.1 (0.41–2.95) 2.70 (1.20–6.12) | 0.043 (0.855) (0.017) | 0 (0–1000) 1.87 (0.31–11.3) | 0.793 (0.973) (0.496) | 0 (0–10,000) 1.53 (0.50–4.71) | 0.761 (0.959) (0.461) | ||||
Current smoking (referent: absent) | 0.49 (0.12–2.04) | 0.324 | 0.04 (0–6701) | 0.605 | 0.77 (0.10–5.94) | 0.803 | ||||||
BMI ≥ 25 kg/m2 (referent: <25 kg/m2) | 0.75 (0.31–1.84) | 0.528 | 0.03 (0–388) | 0.470 | 1.41 (0.35–5.62) | 0.631 | ||||||
Renal replacement therapy (referent: hemodialysis) | 0.69 (0.21–2.26) | 0.535 | 0.04 (0–1717) | 0.551 | 0.76 (0.10–6.02) | 0.797 | ||||||
Prior abdominal surgery (referent: absent) | 0.62 (0.30–1.31) | 0.212 | 0.26 (0.03–2.30) | 0.226 | 0.51 (0.14–1.86) | 0.309 | ||||||
CCI (referent: ≤4) | 2.51 (1.23–5.12) | 0.012 | 2.16 (1.01–4.63) | 0.048 | 1.41 (0.27–7.31) | 0.680 | 1.88 (0.61–5.75) | 0.269 | ||||
ASA score 3 (referent: ASA 2) | 1.44 (0.34–6.07) | 0.616 | 23.1 (0–10,000) | 0.651 | 22.9 (0–10,000) | 0.539 | ||||||
Operative methods (referent: laparoscopic) | 1.03 (0.50–2.11) | 0.942 | 0.89 (0.16–4.86) | 0.888 | 1.16 (0.36–3.77) | 0.804 | ||||||
UTUC stage 3/4 (referent: ≤stage 2) | 1.68 (0.78–3.61) | 0.183 | 11.0 (1.92–63.0) | 0.007 | 1000 (0–10,000) | 0.943 | 4.03 (1.35–12.0) | 0.012 | 5.80 (1.42–23.6) | 0.014 | ||
Bladder stage 3/4 (referent: ≤stage 2) | 6.61 (2.76–15.8) | 0.000 | 12.4 (1.82–84.7) | 0.010 | 34.0 (5.41–213) | 0.000 | 1000 (0–10,000) | 0.931 | 24.3 (7.89–74.7) | 0.000 | 57.3 (5.42–605) | 0.001 |
Tumor grade (referent: low grade) | 0.63 (0.15–2.66) | 0.526 | 21.7 (0–10,000) | 0.737 | 0.62 (0.08–4.79) | 0.649 | ||||||
Lymphovascular invasion (referent: absent) | 2.54 (1.04–6.18) | 0.040 | 0.30 (0.04–2.18) | 0.235 | 5.70 (1.03–31.6) | 0.046 | 0 (0–10,000) | 0.943 | 9.13 (3.0327.5) | 0.000 | 0.25 (0.02–2.91) | 0.270 |
Positive surgical margin (referent: absent) | 2.68 (0.62–11.6) | 0.186 | 0.05 (0–10,000) | 0.822 | 9.15 (2.42–34.6) | 0.001 | 3.54 (0.56–22.3) | 0.178 | ||||
Carcinoma in situ (referent: absent) | 0.86 (0.36–2.09) | 0.741 | 0.03 (0–154.3) | 0.427 | 0.04 (0–15.1) | 0.281 | ||||||
Adjuvant therapy (referent: absent) | 1.77 (0.77–4.07) | 0.181 | 7.19 (1.44–36.0) | 0.016 | 1.30 (0.15–11.1) | 0.812 | 5.57 (1.87–16.6) | 0.002 | 0.56 (0.12–2.67) | 0.465 | ||
Clavien surgical complications (referent: ≤2) | 3.01 (1.51–6.0) | 0.002 | 2.06 (1.0–4.24) | 0.051 | 5.10 (0.89–29.3) | 0.067 | 3.55 (1.16–10.9) | 0.026 | 3.29 (0.72–15.1) | 0.126 | ||
One-stage CUTE (referent: multiple-stage) | 1.19 (0.55–2.55) | 0.657 | 0.86 (0.16–4.71) | 0.862 | 0.62 (0.20–1.91) | 0.409 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. 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/).
Share and Cite
Huang, Y.-C.; Liu, Y.-L.; Chen, M.-F.; Chen, C.-S.; Wu, C.-T. Treatment Strategy for Dialysis Patient with Urothelial Carcinoma. Diagnostics 2021, 11, 1966. https://doi.org/10.3390/diagnostics11111966
Huang Y-C, Liu Y-L, Chen M-F, Chen C-S, Wu C-T. Treatment Strategy for Dialysis Patient with Urothelial Carcinoma. Diagnostics. 2021; 11(11):1966. https://doi.org/10.3390/diagnostics11111966
Chicago/Turabian StyleHuang, Yun-Ching, Yu-Liang Liu, Miao-Fen Chen, Chih-Shou Chen, and Chun-Te Wu. 2021. "Treatment Strategy for Dialysis Patient with Urothelial Carcinoma" Diagnostics 11, no. 11: 1966. https://doi.org/10.3390/diagnostics11111966