Preoperative Hydronephrosis: Independent Predictor for Changes in Renal Function Following Nephroureterectomy

Partial or complete urinary obstruction caused by a tumor itself may affect renal function and the eligibility for perioperative cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma. We investigated whether the status of preoperative hydronephrosis provides additional predictive information concerning changes in perioperative renal function. A total of 155 patients who underwent nephroureterectomy for upper tract urothelial carcinoma from 1997 to 2010 were identified. The association between preoperative parameters including the grade of hydronephrosis and perioperative renal function was analyzed. Hydronephrosis was observed in 104 patients. The grade of hydronephrosis was 1, 2, 3 and 4 in 6 (3.9), 25 (16.1), 42 (27.1) and 31 (20.0) cases. Using a defined cut-off creatinine clearance value of epsilon 50 ml/min indicating eligibility for cisplatin-based chemotherapy, only 94 patients (60.6) were eligible in the neoadjuvant setting. Of these 94 patients, 30 (31.9) were judged to be ineligible in the adjuvant setting. Multivariate analysis demonstrated that patient age epsilon 70 years [P 0.001, hazard ratio (HR) 27.9] and the absence of a higher grade hydronephrosis (P 0.013, HR 7.40) were independent risk factors for predicting patients ineligible to receive adjuvant cisplatin-based chemotherapy. The proportion of patients ineligible to receive cisplatin-based chemotherapy changed from 40.9 to 88.6 following nephroureterectomy in patients aged epsilon 70 years and those with no or a lower grade hydronephrosis. The status of hydronephrosis is an independent predictor of eligibility to receive adjuvant cisplatin-based chemotherapy. The information on preoperative hydronephrosis and patient age may assist in part of the decision-making when considering neoadjuvant cisplatin-based chemotherapy.