Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Jpn J Clin Oncol. 2012 Mar;42(3):202-7. doi: 10.1093/jjco/hyr199. Epub 2012 Jan 13.
Partial or complete urinary obstruction caused by a tumor itself may affect renal function and the eligibility for perioperative cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma. We investigated whether the status of preoperative hydronephrosis provides additional predictive information concerning changes in perioperative renal function.
A total of 155 patients who underwent nephroureterectomy for upper tract urothelial carcinoma from 1997 to 2010 were identified. The association between preoperative parameters including the grade of hydronephrosis and perioperative renal function was analyzed.
Hydronephrosis was observed in 104 patients. The grade of hydronephrosis was 1, 2, 3 and 4 in 6 (3.9%), 25 (16.1%), 42 (27.1%) and 31 (20.0%) cases. Using a defined cut-off creatinine clearance value of ≥50 ml/min indicating eligibility for cisplatin-based chemotherapy, only 94 patients (60.6%) were eligible in the neoadjuvant setting. Of these 94 patients, 30 (31.9%) were judged to be ineligible in the adjuvant setting. Multivariate analysis demonstrated that patient age ≥70 years [P < 0.001, hazard ratio (HR) 27.9] and the absence of a higher grade hydronephrosis (P = 0.013, HR 7.40) were independent risk factors for predicting patients ineligible to receive adjuvant cisplatin-based chemotherapy. The proportion of patients ineligible to receive cisplatin-based chemotherapy changed from 40.9 to 88.6% following nephroureterectomy in patients aged ≥70 years and those with no or a lower grade hydronephrosis.
The status of hydronephrosis is an independent predictor of eligibility to receive adjuvant cisplatin-based chemotherapy. The information on preoperative hydronephrosis and patient age may assist in part of the decision-making when considering neoadjuvant cisplatin-based chemotherapy.
肿瘤本身引起的部分或完全尿路梗阻可能会影响上尿路上皮癌患者的肾功能和围手术期顺铂为基础的化疗的适应证。我们研究了术前肾积水的状态是否提供了关于围手术期肾功能变化的额外预测信息。
共纳入 1997 年至 2010 年间接受肾输尿管切除术治疗上尿路上皮癌的 155 例患者。分析术前参数（包括肾积水程度）与围手术期肾功能之间的关系。
104 例患者存在肾积水。肾积水程度为 1、2、3 和 4 级的分别有 6（3.9%）、25（16.1%）、42（27.1%）和 31（20.0%）例。使用定义的肌酐清除率≥50ml/min 作为有资格接受顺铂为基础的化疗的截定点，新辅助治疗中有 94 例（60.6%）患者符合条件。在这 94 例患者中，30 例（31.9%）在辅助治疗中被判定为不符合条件。多因素分析显示，年龄≥70 岁的患者[P<0.001，风险比（HR）27.9]和无较高级别肾积水（P=0.013，HR 7.40）是预测患者不适合接受辅助顺铂为基础化疗的独立危险因素。在年龄≥70 岁的患者和无或低级别肾积水的患者中，接受肾输尿管切除术后不适合接受顺铂为基础化疗的患者比例从 40.9%增加到 88.6%。
肾积水的状态是接受辅助顺铂为基础化疗的适应证的独立预测因子。术前肾积水和患者年龄的信息可能有助于在考虑新辅助顺铂为基础化疗时部分决策。
