Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy
Standard
Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy. / 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; UTUC Collaboration.
in: BJU INT, Jahrgang 112, Nr. 4, 01.08.2013, S. 453-61.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy
AU - Xylinas, Evanguelos
AU - Rink, Michael
AU - Margulis, Vitaly
AU - Clozel, Thomas
AU - Lee, Richard K
AU - Comploj, Evi
AU - Novara, Giacomo
AU - Raman, Jay D
AU - Lotan, Yair
AU - Weizer, Alon
AU - Roupret, Morgan
AU - Pycha, Armin
AU - Scherr, Douglas S
AU - Seitz, Christian
AU - Ficarra, Vincenzo
AU - Trinh, Quoc-Dien
AU - Karakiewicz, Pierre I
AU - Montorsi, Francesco
AU - Zerbib, Marc
AU - Shariat, Shahrokh F
AU - UTUC Collaboration
N1 - © 2013 BJU International.
PY - 2013/8/1
Y1 - 2013/8/1
N2 - UNLABELLED: What's known on the subject? and what does the study add?: 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. 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(2) , 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.OBJECTIVE: 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.PATIENT AND METHODS: We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. 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).RESULTS: 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(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 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 (P < 0.001). 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 (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses.CONCLUSIONS: In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU.
AB - UNLABELLED: What's known on the subject? and what does the study add?: 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. 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(2) , 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.OBJECTIVE: 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.PATIENT AND METHODS: We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. 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).RESULTS: 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(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 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 (P < 0.001). 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 (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses.CONCLUSIONS: In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU.
KW - Aged
KW - Carcinoma, Transitional Cell
KW - Female
KW - Glomerular Filtration Rate
KW - Humans
KW - Kidney Function Tests
KW - Kidney Neoplasms
KW - Male
KW - Middle Aged
KW - Nephrectomy
KW - Patient Selection
KW - Retrospective Studies
KW - Survival Rate
KW - Ureter
U2 - 10.1111/j.1464-410X.2012.11649.x
DO - 10.1111/j.1464-410X.2012.11649.x
M3 - SCORING: Journal article
C2 - 23464979
VL - 112
SP - 453
EP - 461
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 4
ER -