顺铂为基础化疗治疗晚期尿路上皮癌患者中孤立肾与双侧肾功能患者肾毒性的比较：一项日本回顾性多机构研究。
A comparison of nephrotoxicity between patients with a solitary-functioning kidney and those with bilateral-functioning kidneys in cisplatin-based chemotherapy for advanced urothelial carcinoma: a Japanese retrospective multi-institutional study.
机构信息
Department of Urology, Akita University Graduate School of Medicine, Akita, 010-8543, Japan.
Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305‑8575, Japan.
出版信息
BMC Cancer. 2018 Mar 14;18(1):290. doi: 10.1186/s12885-018-4186-z.
BACKGROUND
To compare the prevalence of nephrotoxicity between patients with a solitary-functioning kidney versus those with bilateral-functioning kidneys during the administration of cisplatin-based chemotherapy for advanced urothelial carcinoma.
METHODS
We retrospectively analyzed 244 advanced urothelial carcinoma patients treated with cisplatin-based chemotherapy between 2004 and 2010 at 17 institutes in Japan. The 24 h creatinine clearance, Cockcroft-Gault formula, and estimated glomerular filtration rate equation (eGFR), were compared before all chemotherapies. The urinary tract function status was determined based on the data of nephroureterectomy, hydronephrosis, and relief of upper urinary tract obstruction. A total of 244 patients were divided into four groups according to their urinary tract functioning status and eGFR results, including bilateral-functioning kidneys with pretreatment eGFR ≥60 mL/min/1.73 m group (n = 83, 34.0%); a solitary-functioning kidney with pretreatment eGFR ≥60 mL/min/1.73 m group (n = 36, 14.8%); bilateral-functioning kidneys with pretreatment eGFR < 60 mL/min/1.73 m group (n = 45, 18.4%); and a solitary-functioning kidney with pretreatment eGFR < 60 mL/min/1.73 m group (n = 80, 32.8%).
RESULTS
The prevalence of nephrotoxicity with impaired eGFR of > 10% and 30% from baseline in the post-third-course of chemotherapy was significantly higher in patients with bilateral-functioning kidneys than in those with a solitary-functioning kidney, among patients with pretreatment eGFR < 60 mL/min/1.73 m (p = 0.023 and p = 0.026). During all courses of chemotherapy, the prevalence of nephrotoxicity with impaired eGFR of > 20% from baseline were significantly higher in patients with bilateral-functioning kidneys than those with a solitary-functioning kidney among patients with pretreatment eGFR < 60 mL/min/1.73 m (p = 0.034), whereas no significant difference was observed among patients with pretreatment eGFR ≥60 mL/min/1.73 m.
CONCLUSIONS
The results suggest that cisplatin-based chemotherapy may have more nephrotoxicity in patients with bilateral-functioning kidneys than in those with a solitary-functioning kidney.
背景
比较在接受顺铂为基础的化疗治疗晚期尿路上皮癌的过程中，单功能肾与双侧肾功能患者的肾毒性发生率。
方法
我们回顾性分析了 2004 年至 2010 年间在日本 17 个机构接受顺铂为基础化疗的 244 例晚期尿路上皮癌患者。在所有化疗前比较 24 小时肌酐清除率、 Cockcroft-Gault 公式和估计肾小球滤过率方程（eGFR）。根据肾输尿管切除术、肾积水和上尿路梗阻缓解的数据确定尿路功能状态。根据治疗前 eGFR≥60 mL/min/1.73 m 时的尿路功能状态和 eGFR 结果，将 244 例患者分为四组，包括预处理 eGFR≥60 mL/min/1.73 m 的双侧肾功能组（n=83，34.0%）；预处理 eGFR≥60 mL/min/1.73 m 的单功能肾组（n=36，14.8%）；预处理 eGFR<60 mL/min/1.73 m 的双侧肾功能组（n=45，18.4%）和预处理 eGFR<60 mL/min/1.73 m 的单功能肾组（n=80，32.8%）。
结果
在预处理 eGFR<60 mL/min/1.73 m 的患者中，与单功能肾患者相比，预处理 eGFR<60 mL/min/1.73 m 的患者中，在第三疗程后，eGFR 下降>10%和 30%的肾毒性发生率在双侧肾功能患者中明显更高（p=0.023 和 p=0.026）。在所有化疗过程中，在预处理 eGFR<60 mL/min/1.73 m 的患者中，与单功能肾患者相比，eGFR 下降>20%的肾毒性发生率在双侧肾功能患者中明显更高（p=0.034），而在预处理 eGFR≥60 mL/min/1.73 m 的患者中则无显著差异。
结论
结果表明，与单功能肾患者相比，顺铂为基础的化疗可能对双侧肾功能患者的肾毒性更大。
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