Oncologic and survival outcomes in patients undergoing radical nephroureterectomy with preoperative or iatrogenic dialysis dependence

Purpose: Radical nephroureterectomy (RNU) is the gold standard treatment for high-risk upper tract urothelial carcinoma (UTUC). However, the oncologic control afforded by RNU may be accompanied by significant renal function decline. Data regarding patients with immediate end-stage renal disease (ESRD) after RNU is limited. Herein, we investigate outcomes of patients undergoing RNU who were dialysis-dependent prior to surgery or rendered anephric by surgery relative to a matched control cohort. Materials and Methods: We queried our multi-institutional RNU database to identify patients with preoperative ESRD (n = 16) or solitary kidney (n = 12). We matched these 1:2 to a control cohort of RNU patients using age, sex, Charlson Comorbidity Index, smoking status, and pathologic T-stage. Oncologic and survival outcomes were compared using the Kaplan–Meier method. Results: The two groups had similar baseline clinical and oncologic characteristics, including utilization of perioperative systemic therapy. There was no significant difference in time to recurrence or cancer specific mortality. However, the dialysis cohort displayed a higher risk of overall mortality, with 3- and 5-year survival of 29% and 14%, compared to 60% and 57% in the control group (HR 2.13, P = 0.03). Conclusions: Patients undergoing RNU with immediate postoperative ESRD had similar oncologic outcomes but worse overall survival compared to matched controls. These results are likely related to the impact of ESRD and other nononcologic comorbidities, which must factor into treatment decisions. For those who ultimately elect RNU, all efforts should be made to optimize any potentially reversible comorbidities after surgery.