Hypertension Linked to Worse Upper Tract Urothelial Cancer Outcomes

Abstract

Hypertension: HypertensionJust as there are many different types of cancer that exist across patient populations, the independent risk factors impacting cancers vary. As both cancer and hypertension independently impact large patient populations, their association has justified previous research. For example, one nationwide, population-based study found that there was a positive association between hypertension and subsequent urinary bladder cancer, including urothelial carcinoma (Ups J Med Sci 2018; doi: 10.1080/03009734.2018.1473534). Yet, an area that has proven to be understudied is the impact of hypertension on oncologic outcomes in upper tract urothelial carcinoma—specifically with regard to intravesical recurrence after radical nephroureterectomy. To provide new insight, a team of researchers led by Sohail Dhanji, MD, further explored this topic and the patient impact. Upon completion, he and his team presented their findings at the 2023 American Urological Association Annual Meeting, bringing about new, related questions and the need for subsequent research. Initially, Dhanji became directly involved in the project due to his role as a research fellow at the University of California at San Diego School of Medicine Department of Urology under the mentorship of Ithaar Derweesh, MD, in March 2022. He credits Derweesh's influence as to what helped make this research possible. Through his instruction, Dhanji explained he was able to learn the skills needed to perform this research and gain access to the information needed to complete this study. “Our team does a lot of database research, as we are a part of many multi-institutional databases. Initially, we were looking for a link between [body mass index] and outcomes for patients with [upper tract urothelial cancer],” Dhanji shared. “However, hypertension kept standing out as a significant risk factor so we decided to pivot to that as the focus of our research.” Before this study, Dhanji explained that the known impact of hypertension on upper tract urothelial cancer patients undergoing nephroureterectomy was minimal. As a result, he and his team utilized a ROBUUST [ROBotic surgery for Upper tract Urothelial cancer STudy] database. It was formed by merging data collected over time from patients at 20 centers, and then using this data to evaluate the potential relationship between hypertension and upper tract urothelial cancer patients undergoing nephroureterectomy. According to Dhanji, data was pulled from these centers in particular because they were seen as centers of excellence when it comes to urologic oncology. Using a sample of 865 patients who have received a radical nephroureterectomy in the last 17 years, the researchers followed up with each at a mean interval of 30.5 months to assess several areas of interest. These included overall survival rates, cancer-specific survival rates, and recurrence-free survival (stratified by HTN status). A Kaplan-Meier analysis was also performed to analyze overall outcomes for these rates. “Kaplan-Meier analysis is [another] effective tool for comparing the survival of different populations,” Dhanji said. “A key factor of this analysis is the P value. A P value less than .05 is considered to be indicative of a statistically significant difference between two populations.” To assess the data, patients were divided into groups based on hypertension status. Of the total number of patients observed, 488 had previously been diagnosed with hypertension, leaving 377 free from hypertension symptoms. According to the Mayo Clinic, hypertension is diagnosed when a patient's blood pressure reading is equal to or greater than 130/80 mm Hg, and only after two or more readings have been taken on separate occasions. Upon the completion of the study, researchers found that the upper tract urothelial cancer patients undergoing nephrectomy and who had been diagnosed with hypertension had a 66.9 percent 3-year overall survival rate. This was compare