Characteristics and outcomes of patients with hydronephrosis at initial bladder cancer diagnosis: A single-site 13-year retrospective study
Wasim Hajuthman, Sanya Caratella, Egemen Tezcan, Xueke Wang, Brian Ho, Mohammad Abdul Chowdry, Rammah Abdlbagi, Amit Sandhu, Aakash PaiAbstract
Background:
Traditional diagnostic process in bladder cancer includes cystoscopy and TURBT to confirm the pathology and staging, namely the muscle invasive status, as it has significant prognostic implications and determines treatment options. Hydronephrosis has been seen as an indicator of poor prognosis. There is a paucity of data on the characteristics and outcomes of bladder cancer patients with hydronephrosis at presentation. Specifically, the proportion of hydronephrotic patients with muscle-invasive and nonmuscle-invasive (NMI) disease needs to be elucidated.
Methods:
We retrospectively reviewed the records of 1440 consecutive patients newly diagnosed with bladder cancer identified using the Cancer Registry at our institution between January 2008 and January 2021.
Results:
Of the 1440 patients with newly diagnosed bladder cancer, hydronephrosis was diagnosed at presentation in 87 patients. Four patients were excluded due to alternative pathologies causing hydronephrosis. The overall incidence of hydronephrosis was 5.76%. Unilateral and bilateral hydronephrosis were identified in 62 (75%) and 21 (25%) patients, respectively. In both cohorts, a high burden of comorbidity was evident, with 94.7% of the nonmuscle-invasive group and 93.8% of the muscle-invasive group demonstrating a Charlson Comorbidity Index score of ≥ 5, indicative of severe comorbid status. Of the 83 patients included in the study, 64 (77.1%) patients had muscle-invasive disease, and 19 (22.9%) patients were diagnosed with NMI disease. In the NMI cohort, five patients underwent radical cystectomy. Two-year cancer-specific survival for this cohort was 64%. In the muscle-invasive cohort, median overall survival was 6 months.
Conclusion:
Hydronephrosis may not always indicate muscle-invasive bladder cancer; however, it appears to be a poor prognostic indicator. Patients with NMI bladder cancer showed a considerable risk of progression. Fit patients with nonmetastatic disease should be offered radical treatment.