Yamamoto Satoshi, Kurokawa Koichiro, Watanabe Koki, Kanaoka Sanji, Nakamura Kazuyoshi
Urology, Kimitsu Chuo Hospital, Kisarazu, JPN.
Cureus. 2025 Apr 14;17(4):e82261. doi: 10.7759/cureus.82261. eCollection 2025 Apr.
Background This study aims to assess the impact of reduced cisplatin doses on treatment efficacy and toxicity in patients with urothelial carcinoma (UC) and renal impairment. Current guidelines suggest excluding patients with renal impairment from cisplatin treatment. However, reevaluating the efficacy of dose-adjusted cisplatin based on renal function is crucial. Methods A retrospective study was conducted on 68 patients diagnosed with locally advanced or metastatic UC (T2-4N0M0, TanyN1-3M0 or TanyNanyM1) between 2017 and 2024. These patients were divided into two groups: 40 received a full dose (100%) of cisplatin (CDDP:70-135mg) and 28 received a 75% dose (CDDP:60-120mg). Clinical outcomes and adverse effects were analyzed and compared between these two groups, with a particular focus on patients with renal impairment (estimated glomerular filtration rate (eGFR) 50-60). Results Complete response (CR) rates were 15.0% for the full-dose group and 14.3% for the 75% dose group, while partial response (PR) rates were 35.0% and 42.9%, respectively. The overall response rates (CR + PR) were 50.0% for the full dose and 57.2% for the 75% dose. For patients with renal impairment, the 75% dose group demonstrated similar efficacy and adverse effect profiles compared to the full-dose group. Conclusions The findings suggest that reduced doses of cisplatin, based on renal function, do not compromise treatment efficacy in UC patients. Thus, expanding cisplatin eligibility to include UC patients with renal impairment (eGFR 30-60 mL/min) is warranted, indicating that dose-adjusted cisplatin treatment is a viable option.
背景 本研究旨在评估顺铂剂量减少对尿路上皮癌（UC）合并肾功能损害患者治疗疗效和毒性的影响。当前指南建议将肾功能损害患者排除在顺铂治疗之外。然而，基于肾功能重新评估剂量调整后的顺铂疗效至关重要。方法 对2017年至2024年间诊断为局部晚期或转移性UC（T2 - 4N0M0、TanyN1 - 3M0或TanyNanyM1）的68例患者进行了一项回顾性研究。这些患者被分为两组：40例接受全剂量（100%）顺铂（CDDP：70 - 135mg），28例接受75%剂量（CDDP：60 - 120mg）。分析并比较了两组的临床结局和不良反应，特别关注肾功能损害患者（估计肾小球滤过率（eGFR）50 - 60）。结果 全剂量组的完全缓解（CR）率为15.0%，75%剂量组为14.3%，而部分缓解（PR）率分别为35.0%和42.9%。总体缓解率（CR + PR）全剂量组为50.0%，75%剂量组为57.2%。对于肾功能损害患者，75%剂量组与全剂量组相比显示出相似的疗效和不良反应特征。结论 研究结果表明，根据肾功能减少顺铂剂量不会损害UC患者的治疗疗效。因此，有必要扩大顺铂适用范围，将肾功能损害（eGFR 30 - 60 mL/min）的UC患者纳入其中，这表明剂量调整后的顺铂治疗是一种可行的选择。
