Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
Clin Genitourin Cancer. 2012 Mar;10(1):15-20. doi: 10.1016/j.clgc.2011.10.004. Epub 2011 Nov 29.
Although a creatinine clearance (CrCl) of <60 mL/min, as calculated by the Cockroft-Gault (CG) equation, is a commonly used threshold for "cisplatin-ineligibility," the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has recently emerged as a more accurate method of estimating renal function. We sought to determine the impact of using the CKD-EPI equation for estimating renal function on cisplatin eligibility.
All patients pathologically diagnosed with muscle invasive and/or metastatic bladder urothelial carcinoma (T2-4, N or M positive) at Mount Sinai Medical Center between January 1, 2000, and January 27, 2011, were identified. For each patient, CrCl was estimated by using the CG equation and glomerular filtration rate (GFR) was estimated by using the CKD-EPI equation. The patients were considered cisplatin-ineligible if CrCl <60 mL/min or if GFR was <60 mL/min per 1.73 m(2).
A total of 116 patients were included. The median CrCl estimated by CG was 58.93 mL/min, whereas the median GFR estimated by CKD-EPI was 64.67 mL/min per 1.73 m(2). When using the CG formula, 53% of our cohort was cisplatin ineligible, whereas 46% of the cohort was ineligible when using the CKD-EPI formula. The probability of deeming a patient ineligible when using the CG formula was 17% higher than the probability of deeming a patient ineligible when using the CKD-EPI formula: PR 1.17 (95% CI, 1.03-1.34); P = .0203.
In our retrospective study, the CKD-EPI formula was less likely to deem a patient ineligible for cisplatin-based therapy compared with the CG formula. This finding was hypothesis generating, and prospective evaluation is necessary to determine the clinical relevance of using this more accurate method of renal function assessment in chemotherapy decision making.
虽然 Cockroft-Gault（CG）方程计算的肌酐清除率（CrCl）<60 mL/min 被用作“顺铂不适用”的常用阈值，但慢性肾脏病流行病学合作（CKD-EPI）方程最近已成为一种更准确的肾功能估计方法。我们旨在确定使用 CKD-EPI 方程估计肾功能对顺铂适用性的影响。
在 2000 年 1 月 1 日至 2011 年 1 月 27 日期间，在西奈山医疗中心病理诊断为肌肉浸润性和/或转移性膀胱尿路上皮癌（T2-4，N 或 M 阳性）的所有患者均被确定。对于每位患者，使用 CG 方程估计 CrCl，使用 CKD-EPI 方程估计肾小球滤过率（GFR）。如果 CrCl<60 mL/min 或 GFR<60 mL/min/1.73 m²，则认为患者不适用顺铂。
共有 116 名患者被纳入研究。CG 估计的 CrCl 中位数为 58.93 mL/min，而 CKD-EPI 估计的 GFR 中位数为 64.67 mL/min/1.73 m²。使用 CG 公式时，我们队列的 53%不适用顺铂，而使用 CKD-EPI 公式时，队列的 46%不适用。使用 CG 公式判断患者不适用的概率比使用 CKD-EPI 公式高 17%：PR 1.17（95%CI，1.03-1.34）；P =.0203。
在我们的回顾性研究中，与 CG 公式相比，CKD-EPI 公式不太可能将患者判定为不适用顺铂为基础的治疗。这一发现是假设产生的，需要前瞻性评估以确定在化疗决策中使用这种更准确的肾功能评估方法的临床相关性。
