Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro‐ureterectomy. (6th March 2013)

• Record Type: Journal Article
• Authors: Xylinas, Evanguelos; Rink, Michael; Margulis, Vitaly; Clozel, Thomas; Lee, Richard K.; Comploj, Evi; Novara, Giacomo; Raman, Jay D.; Lotan, Yair; Weizer, Alon; Roupret, Morgan; Pycha, Armin; Scherr, Douglas S.; Seitz, Christian; Ficarra, Vincenzo; Trinh, Quoc‐Dien; Karakiewicz, Pierre I.; Montorsi, Francesco; Zerbib, Marc; Shariat, Shahrokh F.
• Is Part Of: BJU international. Volume 112:Number 4(2013:Aug.)
• Page Start: 453
• Page End: 461
• Publication Date: 2013-03-06
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11649.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11649-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11649-list-1001" list-type="bullet"> <list-item> <p>Radical nephroureterectomy (RNU), the standard of care treatment for high‐risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies.</p> </list-item> <list-item> <p>The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin‐based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m<sup>2</sup>, respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin‐based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting.</p> </list-item> </list> </p> </sec> <sec id="bju11649-sec-0002" sec-type="section"> <title>Objective</title> <p> <list id="bju11649-list-0001" list-type="bullet"> <list-item> <p>To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro‐ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin‐based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.</p> </list-item> </list> </p> </sec> <sec id="bju11649-sec-0003" sec-type="section"> <title>Patient and Methods</title> <p> <list id="bju11649-list-0002" list-type="bullet"> <list-item> <p>We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007.</p> </list-item> <list-item> <p>The eGFR was calculated at baseline and at 3–6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD‐EP) equations).</p> </list-item> </list> </p> </sec> <sec id="bju11649-sec-0004" sec-type="section"> <title>Results</title> <p> <list id="bju11649-list-0003" list-type="bullet"> <list-item> <p>The median (interquartile range) eGFR decreased by 18.2 (8–12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m<sup>2</sup>, which decreased to 16% after RNU (<italic>P</italic> < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m<sup>2</sup>, which decreased to 52% after RNU (<italic>P</italic> < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3–pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (<italic>P</italic> < 0.001).</p> </list-item> <list-item> <p>None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer‐specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (<italic>n</italic> = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m<sup>2</sup> (<italic>P</italic> = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m<sup>2</sup> (<italic>P</italic> = 0.04) were associated with better overall survival in univariable analyses.</p> </list-item> </list> </p> </sec> <sec id="bju11649-sec-0005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11649-list-0004" list-type="bullet"> <list-item> <p>In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU.</p> </list-item> <list-item> <p>Renal function did not affect cancer‐specific outcomes after RNU.</p> </list-item> </list> </p> </sec> </abstract>