Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Biostatistics and Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Urol Oncol. 2022 Oct;40(10):454.e17-454.e23. doi: 10.1016/j.urolonc.2022.06.014. Epub 2022 Aug 10.
Renal function dictates sequencing and eligibility for definitive therapy in upper tract urothelial carcinoma. We investigated longitudinal glomerular filtration rate (GFR) changes after neoadjuvant chemotherapy (NAC) and nephroureterectomy (RNU).
Patients treated with ≥3 cycles of chemotherapy prior to RNU for UTUC from 2000 to 2019 were included. GFR was calculated by CKD-Epi before chemotherapy, before RNU, 1 to 3 months, and 12 months post-RNU. Pathologic stage and overall survival were compared in those with stable GFR (+/-10% of baseline) to the rest of the cohort.
One hundred and fifty-two patients received ≥3 cycles of NAC, with 121 (79%) receiving at least 1 cycle of cisplatin. Renal function dropped by mean of 22.3 ml/min/1.73 m from the beginning of chemotherapy to 1-year post-surgery. In patients receiving cisplatin, a mean decline of 26.2 ml/min/1.73 m was observed vs. 8.8 ml/min/1.73 m without cisplatin-based NAC (P < 0.01). GFR after RNU was unchanged between 3 and 12 months postoperatively. At 1 to 3 months after RNU, 19% of patients had GFR<30 ml/min/1.73m. Improvement in GFR during NAC was associated with invasive final pathologic stage (P = 0.018) and worse overall survival (P = 0.049).
In patients managed with NAC prior to RNU, renal function stabilizes at 1 to 3 months post-operatively and remains clinically similar for cisplatin or non-cisplatin-based therapy. Improvement in GFR during NAC was associated with higher pathologic stage and poorer survival, especially in those receiving non-cisplatin-based therapy, an observation that requires further investigation.
肾功能决定了上尿路尿路上皮癌的治疗顺序和资格。我们研究了新辅助化疗（NAC）和肾输尿管切除术（RNU）后肾小球滤过率（GFR）的纵向变化。
纳入 2000 年至 2019 年间接受 RNU 治疗的接受≥3 个周期化疗的 UTUC 患者。在化疗前、RNU 前、1 至 3 个月和 RNU 后 12 个月，通过 CKD-Epi 计算 GFR。比较 GFR 稳定（±基线的 10%）与队列其余部分的患者的病理分期和总生存率。
152 例患者接受了≥3 个周期的 NAC，其中 121 例（79%）接受了至少 1 个周期的顺铂。从化疗开始到手术后 1 年，肾功能平均下降 22.3ml/min/1.73m。接受顺铂治疗的患者，平均下降 26.2ml/min/1.73m，而未接受基于顺铂的 NAC 的患者平均下降 8.8ml/min/1.73m（P<0.01）。RNU 后 3 至 12 个月，GFR 无变化。RNU 后 1 至 3 个月，19%的患者 GFR<30ml/min/1.73m。NAC 期间 GFR 的改善与侵袭性最终病理分期（P=0.018）和总生存率（P=0.049）相关。
在接受 RNU 前接受 NAC 治疗的患者中，肾功能在术后 1 至 3 个月稳定，并且在顺铂或非顺铂基础治疗中保持相似的临床状态。NAC 期间 GFR 的改善与较高的病理分期和较差的生存相关，尤其是在接受非顺铂基础治疗的患者中，这一观察结果需要进一步研究。
