Merouani A, Davidson S A, Schrier R W
Department of Medicine, University of Colorado School of Medicine, Denver 80262, USA.
Am J Nephrol. 1997;17(1):53-8. doi: 10.1159/000169072.
To investigate the increased nephrotoxicity of taxol and cisplatin combination chemotherapy in gynecologic cancers as compared to cisplatin alone, the medical records of 25 patients with gynecological cancers were reviewed for evaluation of nephrotoxicity after chemotherapy treatment. The data included age, serum creatinine, calculated creatinine clearance, initial and cumulative dose of cisplatin and taxol, primary site of the cancer, renal ultrasound and hydration protocols. Renal function was evaluated before, during and 6 months after chemotherapy. Renal dysfunction was defined as a greater than 25% decrease in creatinine clearance. Comparing 11 patients treated with taxol and cisplatin versus 14 treated with cisplatin alone, there was a significant difference in effect on renal function. Nine of 11 patients (81%) treated with the combination chemotherapy had a greater than 25% decrease in creatinine clearance while only 4 of the 14 patients (29%) treated with cisplatin alone had such a decrease in creatinine clearance (p < 0.004). The patients treated with the combination chemotherapy, however, received a higher dose of cisplatin (80.4 vs. 66.4 mg/m2, p < 0.02) and were treated longer (6.7 vs. 4.3 months, p < 0.002). Nevertheless, when the patients were matched for age, initial dose and cumulative dose of cisplatin, a higher frequency of nephrotoxicity persisted in patients treated with taxol and cisplatin as compared to cisplatin alone (72 as compared to 20%, p < 0.02). The patients in both groups were comparably hydrated; prerenal failure and urinary tract obstruction were excluded in all patients. Six months after completion of chemotherapy, a significantly lower creatinine clearance was still observed in patients treated with taxol and cisplatin combination therapy (46 vs. 76 ml/min, p < 0.01). In summary, a retrospective analysis of renal function in patients with gynecological cancers showed an increased nephrotoxicity in patients treated with taxol and cisplatin as compared to cisplatin alone. A prospective study is therefore needed to examine the potential additive toxic effect of the combination of taxol and cisplatin on long-term renal function, including potential preventive interventions.
为研究与单独使用顺铂相比，紫杉醇与顺铂联合化疗在妇科癌症中肾毒性增加的情况，回顾了25例妇科癌症患者化疗后肾毒性评估的病历。数据包括年龄、血清肌酐、计算的肌酐清除率、顺铂和紫杉醇的初始剂量及累积剂量、癌症原发部位、肾脏超声检查及水化方案。在化疗前、化疗期间及化疗后6个月评估肾功能。肾功能不全定义为肌酐清除率下降超过25%。比较11例接受紫杉醇与顺铂联合治疗的患者和14例单独接受顺铂治疗的患者，二者对肾功能的影响存在显著差异。11例接受联合化疗的患者中有9例（81%）肌酐清除率下降超过25%，而单独接受顺铂治疗的14例患者中只有4例（29%）肌酐清除率有如此下降（p<0.004）。然而，接受联合化疗的患者顺铂剂量更高（80.4 vs. 66.4mg/m²，p<0.02）且治疗时间更长（6.7 vs. 4.3个月，p<0.002）。尽管如此，当患者按年龄、顺铂初始剂量和累积剂量匹配时，与单独使用顺铂相比，接受紫杉醇与顺铂联合治疗的患者肾毒性发生率仍然更高（72% 对比20%，p<0.02）。两组患者的水化程度相当；所有患者均排除了肾前性肾衰竭和尿路梗阻。化疗结束6个月后，接受紫杉醇与顺铂联合治疗的患者肌酐清除率仍显著较低（46 vs. 76ml/min，p<0.01）。总之，对妇科癌症患者肾功能的回顾性分析显示，与单独使用顺铂相比，接受紫杉醇与顺铂联合治疗的患者肾毒性增加。因此，需要进行一项前瞻性研究，以检查紫杉醇与顺铂联合使用对长期肾功能的潜在附加毒性作用，包括潜在的预防干预措施。
