Chandrasekar Thenappan, Pugashetti Neil, Durbin-Johnson Blythe, Dall'Era Marc A, Evans Christopher P, deVere White Ralph W, Yap Stanley A
Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto , Toronto, ON, Canada.
Department of Urology, University of California , Davis, Sacramento, CA, USA.
Bladder Cancer. 2016 Oct 27;2(4):441-448. doi: 10.3233/BLC-160071.
To evaluate the patterns of impact of neoadjuvant chemotherapy (NAC) on renal function across the initial year following treatment for muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC). We reviewed the charts of 241 patients who underwent RC for urothelial carcinoma of the bladder between 2003-14 at our institution. Renal function was evaluated at multiple time points (pre-chemotherapy, pre-operatively, post-operatively, 6-12 months follow-up), and then classified by CKD staging. Univariable and multivariable logistic regression analyses were performed to determine relationship between NAC and change in CKD stage. Of the 241 patients who underwent RC for urothelial carcinoma of the bladder, 66 (27%) received NAC and 175 (73%) did not. In multivariable analysis, NAC was significantly associated with a decrease of at least one CKD stage from baseline to post-op ( = 0.009), but not to the 6-12 months follow-up time point ( = 0.050). The loss of GFR in the NAC cohort occurs up-front with chemotherapy, but the peri-operative course is similar to those who underwent cystectomy alone. Of the 15 NAC patients (26.8%) who were Stage 3 CKD prior to chemotherapy, none progressed to a higher stage CKD. NAC is associated with an initial decline in GFR, which then remains stable through the first year following RC. Despite an initial insult, patients receiving NAC are not vulnerable to further deterioration. When appropriately selected, NAC does not appear to result in a clinically significant deterioration of renal function.
为评估新辅助化疗（NAC）对接受根治性膀胱切除术（RC）治疗肌层浸润性膀胱癌（MIBC）后首年肾功能的影响模式。我们回顾了2003年至2014年间在我院接受膀胱尿路上皮癌RC治疗的241例患者的病历。在多个时间点（化疗前、术前、术后、6 - 12个月随访）评估肾功能，然后根据慢性肾脏病（CKD）分期进行分类。进行单变量和多变量逻辑回归分析以确定NAC与CKD分期变化之间的关系。在241例接受膀胱尿路上皮癌RC治疗的患者中，66例（27%）接受了NAC，175例（73%）未接受。在多变量分析中，NAC与从基线到术后至少降低一个CKD分期显著相关（P = 0.009），但与6 - 12个月随访时间点无关（P = 0.050）。NAC队列中肾小球滤过率（GFR）的下降在化疗开始时就出现，但围手术期过程与仅接受膀胱切除术的患者相似。在化疗前为3期CKD的15例NAC患者（26.8%）中，无一人进展到更高阶段的CKD。NAC与GFR的初始下降有关，然后在RC后的第一年保持稳定。尽管有初始损伤，但接受NAC的患者不易进一步恶化。当适当选择时，NAC似乎不会导致肾功能出现临床显著恶化。
