Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients

BJU Int. 2014 May;113(5b):E17-21. doi: 10.1111/bju.12274. Epub 2013 Sep 5.

Abstract

Objective: To determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients.

Patients and methods: Using the Mayo Clinic Cystectomy Registry, we identified 768 patients treated with RC without neoadjuvant chemotherapy for urothelial carcinoma from 1980-2005. Glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and a value of ≥60 mL/min was considered eligible for cisplatin-based chemotherapy. Factors associated with change in GFR (from preoperative to 3-month postoperative) were assessed using linear regression.

Results: The median age was 68 years, while the median GFR was 60 mL/min both preoperatively and 3 months after RC. Overall, 405 (53%) patients had a GFR of <60 mL/min before surgery and 387 (50%) had a GFR of <60 mL/min at 3 months after RC. Patients with hydronephrosis (209 patients) had significantly lower preoperative GFRs than with patients without hydronephrosis (median 52 vs 62 mL/min, respectively; P < 0.001). Among the 363 patients with a GFR of ≥60 mL/min before RC, 91 (25%) had a decline in renal function to a GFR of <60 mL/min at 3 months after RC. In multivariable analyses, older age (P < 0.001), higher preoperative GFR (P < 0.001) and continent urinary diversion (P = 0.011) were significantly associated with a negative change in GFR after RC.

Conclusions: Our results suggest that nearly half of patients undergoing RC are not eligible to receive perioperative cisplatin-based chemotherapy based on renal function status. About a quarter of patients eligible for cisplatin before surgery are no longer eligible after RC. Certain patient characteristics and surgical factors are more likely to experience a negative change in GFR after RC and should be counselled accordingly.

Keywords: cisplatin; cystectomy; glomerular filtration rate; urinary bladder neoplasms.

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Chemotherapy, Adjuvant
  • Cisplatin / therapeutic use*
  • Cystectomy*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Patient Selection*
  • Retrospective Studies
  • Urinary Bladder Neoplasms / drug therapy*
  • Urinary Bladder Neoplasms / physiopathology
  • Urinary Bladder Neoplasms / surgery*

Substances

  • Antineoplastic Agents
  • Cisplatin