Loh Janice M, Tran Adrienne L, Ji Lingyun, Groshen Susan, Daneshmand Siamak, Schuckman Anne, Quinn David I, Dorff Tanya B
Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, CA.
Clin Genitourin Cancer. 2017 Sep 6. doi: 10.1016/j.clgc.2017.08.016.
Cisplatin eligibility for clinical trials has been defined as glomerular filtration rate (GFR) ≥ 60 mL/min due to the risk of nephrotoxicity in patients with renal impairment. For urothelial cancer, substitution of carboplatin instead of cisplatin compromises outcomes. We evaluated change in GFR in patients treated with cisplatin despite baseline GFR < 60 mL/min to determine risk of nephrotoxicity.
Patients treated between 2009 and 2014 at our institution were identified by the institutional review board-approved cystectomy database. GFR percentage change was compared by age (< 75 vs. ≥ 75 years), pretreatment GFR (< 60 vs. ≥ 60 mL/min), therapy setting (neoadjuvant, adjuvant, or metastatic), primary disease site, and comorbidities (diabetes, hypertension, and hyperlipidemia). The associations between overall survival and age or GFR were also assessed.
There were 81 patients who received cisplatin-based therapy and whose pre- and posttreatment GFR were available. Median GFR change was -1.6% for patients with pretreatment GFR < 60 mL/min compared to -10.9% for patients with pretreatment GFR ≥ 60 mL/min (P = .17). Therapy setting was the only factor in our study to be significantly associated with GFR change (P = .027). No association was found between overall survival and pre- or posttreatment GFR, GFR percentage change, or age.
Our data support the hypothesis that urothelial cancer patients with GFR < 60 mL/min do not experience a greater decline in renal function after cisplatin compared to patients with GFR ≥ 60 mL/min. If validated, this may extend the option of cisplatin-based therapy to previously ineligible patients.
由于肾功能不全患者存在肾毒性风险，临床试验中顺铂的适用标准为肾小球滤过率（GFR）≥60 mL/分钟。对于尿路上皮癌，用卡铂替代顺铂会影响治疗效果。我们评估了尽管基线GFR<60 mL/分钟但接受顺铂治疗的患者的GFR变化，以确定肾毒性风险。
通过机构审查委员会批准的膀胱切除术数据库，确定2009年至2014年在我们机构接受治疗的患者。根据年龄（<75岁与≥75岁）、治疗前GFR（<60与≥60 mL/分钟）、治疗方式（新辅助、辅助或转移性）、原发疾病部位和合并症（糖尿病、高血压和高脂血症）比较GFR百分比变化。还评估了总生存期与年龄或GFR之间的关联。
有81例接受基于顺铂治疗且有治疗前和治疗后GFR数据的患者。治疗前GFR<60 mL/分钟的患者GFR中位数变化为-1.6%，而治疗前GFR≥60 mL/分钟的患者为-10.9%（P = 0.17）。治疗方式是我们研究中与GFR变化显著相关的唯一因素（P = 0.027）。未发现总生存期与治疗前或治疗后GFR、GFR百分比变化或年龄之间存在关联。
我们的数据支持以下假设，即与GFR≥60 mL/分钟的患者相比，GFR<60 mL/分钟的尿路上皮癌患者在接受顺铂治疗后肾功能下降幅度不会更大。如果得到验证，这可能会将基于顺铂的治疗选择扩展到以前不符合条件的患者。
