Ho Matthew D, Black Anna J, Zargar Homayoun, Fairey Adrian S, Mertens Laura S, Dinney Colin P, Mir Maria C, Krabbe Laura-Maria, Cookson Michael S, Jacobsen Niels-Erik, Montgomery Jeffrey S, Yu Evan Y, Xylinas Evanguelos, Kassouf Wassim, Dall'Era Marc A, Vasdev Nikhil, Sridhar Srikala S, McGrath John S, Aning Jonathan, Holzbeierlein Jeff M, Thorpe Andrew C, Shariat Shahrokh F, Wright Jonathan L, Morgan Todd M, Bivalacqua Trinity J, North Scott, Barocas Daniel A, Lotan Yair, Grivas Petros, Stephenson Andrew J, Shah Jay B, van Rhijn Bas W, Daneshmand Siamak, Spiess Philippe E, Black Peter C
Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Department of Urology, Western Health, Melbourne, Australia.
Can Urol Assoc J. 2023 Oct;17(10):301-309. doi: 10.5489/cuaj.8570.
Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both.
We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context.
We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/min/1.73 m), and the proportion of those with stage ≥3 CKD increased from 37% to 51%.
Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.
基于顺铂的新辅助化疗（NAC）是接受根治性膀胱切除术（RC）的肌层浸润性膀胱癌（MIBC）患者的标准治疗方法。然而，顺铂可诱发肾毒性。此外，RC是肾损伤的独立危险因素，据报道术后一年估计肾小球滤过率（eGFR）下降高达6 mL/min/1.73 m²。我们的目的是评估基于顺铂的NAC和RC对接受这两种治疗的患者肾功能的影响。
我们分析了一个MIBC患者的多中心数据库，所有患者在RC之前均接受了基于顺铂的NAC。在时间点T1（NAC之前）、T2（NAC之后但RC之前）和T3（RC后一年）收集eGFR值。比较这些时间点之间的eGFR以及eGFR<60 ml/min/1.73m²（慢性肾脏病[CKD]≥3期）患者的比例。由于该数据集中的所有患者均接受了NAC，我们从一个机构中确定了一组同期接受RC但未接受NAC的回顾性队列患者作为对照。
我们确定了234例有可用肾功能数据的患者。在NAC队列中，从T1到T3，eGFR平均下降了17%（13 mL/min/1.73 m²），≥3期CKD患者的比例从27%增加到50%。未接受NAC的平行队列由236例患者组成。该队列的平均基线eGFR低于NAC队列（66 vs. 75 mL/min/1.73 m²）。在这个非NAC队列中，从T1到T3，eGFR平均下降了6%（4 mL/min/1.73 m²），≥3期CKD患者的比例从37%增加到51%。
在RC之前给予NAC与RC后一年eGFR下降17%以及≥3期CKD发病率几乎翻倍相关。未接受NAC而接受RC的患者在基线时≥3期CKD的发生率较高，但在一年时肾功能损失似乎较少。
