MP56-17: The Impact of Baseline Chronic Kidney Disease on Long-term Survivals of Patients Undergoing Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis
Introduction: Radical cystectomy (RC) is a complex surgery with considerable short- and long-term renal and metabolic complications, especially among those with preoperative chronic kidney disease (CKD). The aim of this study is to evaluate the impact of baseline CKD on oncologic and overall survival of patients who underwent RC for bladder cancer. Methods: PubMed, Web of Science, Cochrane Library, and Scopus databases were searched for articles published by September 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. After quality and risk of bias assessments, eligible studies were included in the meta-analysis. The primary outcome was overall survival (OS) and secondary outcomes included cancer-specific survival (CSS) and metastasis-free survival (MFS) of patients with CKD = 3 (estimated glomerular filtration rate (GFR) < 60 mL/min) undergoing RC. In addition, subgroup meta-analyses were performed in patients with different pre-operative CKD stages. Results: Seven articles with 6900 patients were included in this study. In terms of oncological outcomes, MFS was compromised in patients with higher CKD stage by a HR of 1.54 (95% CI 1.15–2.05). In the subgroup analyses, patients with CKD3b and those with CKD stages ? 2 had a significantly worse MFS (HR = 2.94, p ? 0.0001 and HR = 1.45, p = 0.03, respectively) (Figure 1-A). Also, we found that higher CKD stage could reduce CSS (HR 2.09, 95% CI 1.43–3.05). In the subgroup analysis, all subgroup HRs suggest a decreased CSS, however, patients with CKD3b and CKD ? 2 had a significantly worse CSS (HR = 3.94, p ? 0.0001 and HR = 1.88, p = 0.007) (Figure 1-B). Additionally, we found that a higher CKD stage could reduce OS by a HR of 1.47 (95% CI 1.21–1.79). Subgroup analyses showed that patients with CKD3a and CKD3b as well as those with CKD4 had a significantly worse OS (HR = 1.13, p = 0.03; HR = 2.13, p = 0.08; and HR = 1.71, p = 0.002, respectively) (Figure 1-C). Conclusions: Overall and oncological survivals are compromised in patients with CKD undergoing radical cystectomy. This effect is more prominent in patients with higher CKD stages. SOURCE OF Funding: None
