Cancer Res Treat.  2016 Oct;48(4):1293-1301. 10.4143/crt.2016.021.

Poor Preoperative Glycemic Control Is Associated with Dismal Prognosis after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study

• Kang SG
• Hwang EC
• Jung SI
• Yu HS
• Chung HS
• Kang TW
• Kwon DD
• Hwang JE
• Kim JS
• Noh JH
• You JH
• Kim MK
• Oh TH
• Seo IY
• Baik S
• Kim CS
• Kang SH
• Cheon J

• KMID: 2356231
• DOI: http://doi.org/10.4143/crt.2016.021

Abstract

PURPOSE
The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).
MATERIALS AND METHODS
A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival.
RESULTS
The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001).
CONCLUSION
Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.

Keyword

Diabetes mellitus; Transitional cell carcinoma; Prognosis

MeSH Terms

Carcinoma, Transitional Cell
Diabetes Mellitus
Follow-Up Studies
Humans
Prognosis*
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1. Kaplan-Meier plot for recurrence-free survival (A), cancer-specific survival (B), and overall survival (C) in upper tract urothelial carcinoma patients with no diabetes, good preoperative glycemic control, and poor preoperative glycemic control. (A) Recurrence-free survival (overall, p=0.002; no diabetes mellitus [DM] vs. hemoglobin A1c [HbA1c] < 7, p=0.05; no DM vs. HbA1c ≥ 7, p=0.011; HbA1c < 7 vs. HbA1c ≥ 7, p=0.001). (B) Cancer-specific survival (overall, p=0.001; no DM vs. HbA1c < 7, p=0.418; no DM vs. HbA1c < 7, p=0.418; HbA1c < 7 vs. HbA1c ≥ 7, p=0.001). (C) Overall survival (overall, p=0.001; no DM vs. HbA1c < 7, p=0.075; no DM vs. HbA1c ≥ 7, p=0.001; HbA1c < 7 vs. HbA1c ≥ 7, p=0.001).

Reference

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