Hargis J B, Anderson J R, Propert K J, Green M R, Van Echo D A, Weiss R B
Hematology-Oncology Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
Cancer Chemother Pharmacol. 1992;30(4):291-6. doi: 10.1007/BF00686298.
Assessment of renal function prior to cisplatin chemotherapy has long been based on measurement of creatinine clearance by 24-hour urine collection (CrCmeas). Estimated creatinine clearance (CrCest) as calculated from the patient's age, weight, and serum creatinine level has been suggested as an adequate surrogate for CrCmeas, as it provides advantages of improved convenience, decreased cost, and possibly increased accuracy. We studied 847 patients receiving cisplatin-based chemotherapy on Cancer and Leukemia Group B (CALGB) protocols to determine whether the CrCmeas, CrCest, or serum creatinine value or the age of the patient would predict the subsequent genitourinary (GU) toxicity. Both CrCmeas (P = 0.001) and CrCest (P = 0.02) were predictive of subsequent grade 2+ GU toxicity, with CrCmeas being a slightly better predictor. Patient age also influenced subsequent GU toxicity, with the risk increasing with age (P = 0.0008). When patients were classified by age group and by CrCmeas, distinct subgroups were identified, with differences in the risk for grade 2+ GU toxicity ranging from 14% to 32%. Using a logistic model to assess the probability of grade 2+ GU toxicity, we found that an age of greater than or equal to 60 years (P = 0.005), a CrCmeas value of less than 75 ml/min (P = 0.004), and the risk characteristics of the individual cisplatin trial were important, whereas CrCest was not. Furthermore, CrCest proved to be a poor predictor of a CrCmeas value of less than 75 ml/min, "misclassifying" nearly half of the patients to a "lower-risk" subgroup. In summary, both CrCmeas and the patient's age independently provided predictive information concerning cisplatin GU toxicity. Our data support the continued clinical usefulness of determining the CrCmeas value prior to the administration of cisplatin-based chemotherapy to most patients.
长期以来，顺铂化疗前的肾功能评估一直基于通过24小时尿液收集来测量肌酐清除率（CrCmeas）。根据患者的年龄、体重和血清肌酐水平计算得出的估计肌酐清除率（CrCest）已被认为是CrCmeas的合适替代指标，因为它具有便利性提高、成本降低以及可能准确性提高等优点。我们研究了847例按照癌症与白血病B组（CALGB）方案接受基于顺铂化疗的患者，以确定CrCmeas、CrCest、血清肌酐值或患者年龄是否能预测随后的泌尿生殖系统（GU）毒性。CrCmeas（P = 0.001）和CrCest（P = 0.02）均能预测随后的2级及以上GU毒性，其中CrCmeas的预测效果稍好。患者年龄也会影响随后的GU毒性，风险随年龄增加而升高（P = 0.0008）。当根据年龄组和CrCmeas对患者进行分类时，可识别出不同的亚组，2级及以上GU毒性的风险差异在14%至32%之间。使用逻辑模型评估2级及以上GU毒性的概率时，我们发现年龄大于或等于60岁（P = 0.005）、CrCmeas值小于75 ml/分钟（P = 0.004）以及各个顺铂试验的风险特征很重要，而CrCest则不然。此外，事实证明CrCest对CrCmeas值小于75 ml/分钟的预测效果不佳，将近一半的患者被“错误分类”到“低风险”亚组。总之，CrCmeas和患者年龄均独立提供了有关顺铂GU毒性的预测信息。我们的数据支持在对大多数患者进行基于顺铂的化疗之前测定CrCmeas值在临床上仍具有持续的实用性。
