The Prognostic Significance of Elevated Serum Creatinine for the Recurrence and Progression in Superficial Bladder Tumors

Jae Sang Joo; Jun Seok Kim; Seung Il Jung; Taek Won Kang; Dong Deuk Kwon; Chan Choi; Kwangsung Park; Soo Bang Ryu

doi:10.4111/kju.2007.48.9.927

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Joo, Kim, Jung, Kang, Kwon, Choi, Park, and Ryu: The Prognostic Significance of Elevated Serum Creatinine for the Recurrence and Progression in Superficial Bladder Tumors

Original Article

Korean J Urol 2007;48(9):927-932.

Published online: 20 January 2007

DOI: https://doi.org/10.4111/kju.2007.48.9.927

The Prognostic Significance of Elevated Serum Creatinine for the Recurrence and Progression in Superficial Bladder Tumors

Jae Sang Joo, Jun Seok Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Chan Choi¹, Kwangsung Park, Soo Bang Ryu

From the Department of Urology, Chonnam National University Medical School, Gwangju, Korea

¹From the Department of Pathology, Chonnam National University Medical School, Gwangju, Korea

Received 19 April 2007 Revised 19 July 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

There are many prognostic indicators of bladder tumors including clinical, pathological and molecular markers based on tumor-related factors. This study was performed to evaluate the significance of an elevated level of serum creatinine for predicting progression and recurrence of superficial bladder tumors.

Materials and Methods

One hundred forty-seven patients that initially presented with a superficial bladder tumor (pTa or pT1) except for a carcinoma in situ were retrospectively analyzed according to several factors such as tumor stage, grade, size, multiplicity and serum creatinine for tumor recurrence and progression after a primary transurethral resection.

Results

The elevated serum creatinine group consisted of 20 patients 11 patients experienced recurrence (55.0%) and 3 patients experienced progression (15.0%). The control group consisted of 127 patients 39 patients experienced recurrence (30.7%) and 13 patients experienced progression (10.2%). The presence of an elevated level of serum creatinine and tumor multiplicity were statistically significant prognostic factors for tumor recurrence.

Conclusions

These results can be helpful for predicting the prognosis of transitional cell carcinoma of the bladder and for planning therapeutic and follow-up strategies.

Keywords: Urinary bladder neoplasms, Prognosis, Creatinine

References

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Table 1.

Comparison of the patient characteristics between the two groups

	Group I	Group II	p-value
No. of patients	20	127
Mean creatinine (mg/dl)	2.76±1.60	0.96±0.16	0.001
Mean age (years)	64.4±12.5	64.1±12.1	0.728
Sex (male:female)	16:4	102:25	0.974
Mean follow up (months)	36.1±23.1	38.0±22.0	0.745

Group I: elevated creatinine group, Group II: normal creatinine group

Table 2.

Comparison of the tumor characteristics between the two groups

	Group I	Group II	p-value
Stage (Ta/T1)	13/7	77/50	0.662
Grade (PUNLMP/low/high)	0/16/4	8/85/34	0.878
Size (<3cm/≥3cm)	15/5	89/38	0.654
Multiplicity (<3/≥3)	14/6	96/31	0.594
Intravesical treatment	10	73	0.532

Group I: elevated creatinine group, Group II: normal creatinine group, PUNLMP: papillary urothelial neoplasm of low malignant potential

Table 3.

The possible underlying disease for an elevated level of serum creatinine

	No. of patients (n=20)
Diabetes mellitus and hypertension	3
Diabetes mellitus	3
Hypertension	4
Glomerulonephritis	1
Cystic kidney disease	0
Idiopathic	9

Table 4.

Multivariate analysis of the tumor recurrence

	Hazard ratio	p-value	95% CI
Age	1.002	0.881	0.976–1.029
Sex	1.125	0.792	0.469–2.696
Diabetes mellitus	2.063	0.091	0.892–4.772
Hypertension	0.957	0.916	0.424–2.159
Elevated creatinine	2.992	0.006	1.358–6.285
Stage (Ta/T1)	1.733	0.129	0.853–3.522
Grade (PUNLMP/low/high)	2.424	0.221	0.587–10.00
Size (＜3cm/≥3cm)	0.805	0.506	0.424–1.526
Multiplicity (＜3/≥3)	3.374	0.001	1.814–6.275
Intravesical treatment	0.571	0.117	0.283–1.151

PUNLMP: papillary urothelial neoplasm of low malignant potential, CI: confidence interval

Table 5.

Multivariate analysis of the tumor progression

	Hazard ratio	p-value	95% CI
Age	1.073	0.391	0.914–1.260
Sex	0.122	0.242	0.004–4.117
Diabetes mellitus	0.601	0.679	0.054–6.704
Hypertension	0.244	0.327	0.014–4.111
Elevated creatinine	1.260	0.931	0.007–229.6
Stage (Ta/T1)	0.672	0.858	0.009–51.86
Grade (PUNLMP/low/high)	0.532	0.642	0.037–7.623
Size (＜3cm/≥3cm)	7.964	0.163	0.433–146.4
Multiplicity (＜3/≥3)	0.141	0.282	0.004–5.004
Intravesical treatment	3.552	0.592	0.034–366.2

PUNLMP: papillary urothelial neoplasm of low malignant potential, CI: confidence interval

Table 6.

Comparison of the tumor recurrence and progressio between the two groups

	Group I	Group II	p-value
Recurrence (%)	11 (55%)	39 (30.7%)	0.034
1st recurrence interval (months)	12.85±7.66	13.20±10.27	0.799
Early recurrence (＜6 months)	4 (20.0%)	13 (10.2%)	1.000
No. of recurrence	1.46±0.79	1.77±1.01	0.304
Progression interval (months)	28.00±5.29	28.38±6.34	0.839
Progression (%)	3 (15.0%)	13 (10.2%)	1.000

Group I: elevated creat inine group, Grroup II: normal creatinin group

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