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KMID : 0939920160480041293
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대한암학회지
2016 Volume.48 No. 4 p.1293 ~ p.1301
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Poor Preoperative Glycemic Control Is Associated with Dismal Prognosis after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study
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Kang Sung-Gu
Hwang Eu-Chang
Jung Seung-Il
Yu Ho-Song
Chung Ho-Seok
Kang Taek-Won
Kwon Dong-Deuk
Hwang Jun-Eul
Kim Jun-Seok
Noh Joon-Hwa
You Jae-Hyung
Kim Myung-Ki
Oh Tae-Hoon
Seo Ill-Young
Baik Seung
Kim Chul-Sung
Kang Seok-Ho
Cheon Jun
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Abstract
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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.
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KEYWORD
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Diabetes mellitus, Transitional cell carcinoma, Prognosis
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