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Hydronephrosis Is An Independent Predictor Of Poor Clinical Outcomes In Patients Treated For Muscle Invasive Tcc With Radical Cystectomy
Daniel Canter, Thomas Guzzo, Matthew Resnick, Manish Vira, Zhen Chen*, John Tomaszewski*, ricardo sanchez, Keith VanArsdalen, Alan Wein, S. Bruce Malkowicz
University of Pennsylvania, Philadelphia, PA

Introduction: Hydronephrosis is a demonstrable finding during the clinical staging of muscle invasive transitional cell carcinoma. The objective of this study was to evaluate the impact of hydronephrosis on pathologic and clinical outcomes in muscle invasive disease to assess its prognostic significance.
Methods: A retrospective evaluation of a cystectomy data base was performed to identify those patients with hydronephrosis on preoperative imaging. Cox regression analysis and Kaplan Meier tables were developed to evaluate the contribution of this finding to clinical outcomes.
Results: 306 patients treated between 1988 and 2003 with a mean follow up of 45.6 months were analyze. On univariate analysis unilateral and bilateral hydronephrosis conferred a significant risk for cancer related (HR=1.8 and 3.0, SE=0.24 and 0.36) and overall survival (HR=1.4 and 2.5, SE=0.19 and 0.28). Cancer-specific survival at five years was 68%, 54%, and 35% for the patients without hydronephrosis, with unilateral hydronephrosis, and with bilateral hydronephrosis, respectively. Overall survival at five years was 46%, 35%, and 22%. The multivariable analysis demonstrated significant independent risk for recurrence-free survival, cancer specific survival, and overall specific survival. For unilateral hydronephrosis, the hazard ratios were 1.7 (95% CI=1.04-2.78), 1.74 (95% CI=1.05-2.87), and 1.51 (95% CI=1.03-2.23), respectively. For bilateral hydronephrosis, the hazard ratios were 2.97 (95% CI=1.26-7.02), 3.87 (95% CI=1.71-8.78), and 2.75 (95% CI=1.45-5.18).
Conclusions: The presence of pre-operative hydronephrosis confers significant independent risk for reduced cancer specific survival and overall survival. These patients can be easily identified pre-operatively and would benefit from the survival advantage rendered by neoadjuvant chemotherapy.

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