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Diabetes mellitus with poor glycemic control increases bladder cancer recurrence risk in patients with upper urinary tract urothelial carcinoma
Author(s) -
Tai YiSheng,
Chen ChungHsin,
Huang ChaoYuan,
Tai HuaiChin,
Wang ShoMon,
Pu YeongShiau
Publication year - 2015
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2614
Subject(s) - medicine , diabetes mellitus , glycemic , bladder cancer , hazard ratio , proportional hazards model , urology , gastroenterology , urinary system , cancer , endocrinology , confidence interval
Background The association of diabetes mellitus and bladder cancer recurrence following radical nephroureterectomies (RNUs) in patients with upper urinary tract urothelial carcinoma (UTUC) was investigated. Methods Between January 1996 and March 2009, 538 patients with UTUC who received RNU and had no previous bladder cancer histories were enrolled. The clinicopathological characteristics were obtained and used for the analysis of metachronous bladder recurrence by using Cox proportional hazard model. Results The diabetic patients ( N = 104, 19.3%) were elderly (72 vs 67 years, p < 0.001) and had more hypertension (56.7 vs 34.5%, p < 0.001) as compared with non‐diabetic patients. There was no significant difference in the rest of clinicopathological characteristics between patient groups. During the median follow‐up duration of 51 months, bladder recurrences were discovered in 47.1 and 33.1% of diabetic and non‐diabetic patients with UTUC, respectively. Poorly controlled diabetic patients (HbA 1c ≥ 7.0%) exhibited a shorter duration of bladder cancer recurrence‐free survival as compared with those with good glycemic controlled diabetes mellitus and without diabetes mellitus (log‐rank test, p < 0.001 and <0.001, respectively). In the multivariate analysis, male gender [hazard ratio (HR) = 1.67, p = 0.017], ureteral tumour (HR = 1.61, p = 0.020), end‐stage renal disease (HR = 2.09, p = 0.030) and diabetes mellitus with poor glycemic control (HR = 2.10, p < 0.018) independently predicted bladder recurrence after RNU. Conclusions Diabetes mellitus with poor glycemic control (HbA 1c ≥ 7.0%) increases the risk of subsequent bladder cancer recurrence. These results underscore the need for intensive glycemic control and close follow‐up for diabetic patients. Copyright © 2014 John Wiley & Sons, Ltd.