Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients
Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients
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DOI：
10.1111/bju.12274
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发表时间：
2014-05-01
影响因子：
4.5
通讯作者：
Frank, Igor
中科院分区：
文献类型：
--
作者：
Thompson, R. Houston;Boorjian, Stephen A.;Frank, Igor
目的根据我们在根治性膀胱切除术(RC)患者中的经验，确定肾功能是否符合根治性膀胱切除术(RC)患者的要求。患者与方法利用Mayo诊所膀胱切除术登记表，我们确定了1980-2005年间768例未接受新辅助化疗的RC患者。结果中位年龄68岁，术前和术后3个月肾小球滤过率中位数均为60毫升/分钟。总体而言，405例(53%)患者术前肾小球滤过率为60毫升/分钟，91例(25%)肾功能下降至肾小球滤过率。可控尿流改道(P=0.001)和可控性尿流改道(P=0.011)与肾移植术后肾小球滤过率的负性改变显著相关。结论近半数接受肾移植的患者根据肾功能状况不能接受以顺铂为基础的围手术期化疗。约四分之一的术前可接受顺铂治疗的患者在术后不再接受顺铂化疗。某些患者特征和手术因素更容易导致肾小球滤过率的负变化，应给予相应的咨询。
ObjectiveTo determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients.Patients and MethodsUsing the Mayo Clinic Cystectomy Registry, we identified 768 patients treated with RC without neoadjuvant chemotherapy for urothelial carcinoma from 1980-2005.Glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and a value of >= 60 mL/min was considered eligible for cisplatin-based chemotherapy.Factors associated with change in GFR (from preoperative to 3-month postoperative) were assessed using linear regression.ResultsThe median age was 68 years, while the median GFR was 60 mL/min both preoperatively and 3 months after RC.Overall, 405 (53%) patients had a GFR of = 60 mL/min before RC, 91 (25%) had a decline in renal function to a GFR of RC.In multivariable analyses, older age (P < 0.001), higher preoperative GFR (P < 0.001) and continent urinary diversion (P = 0.011) were significantly associated with a negative change in GFR after RC.ConclusionsOur results suggest that nearly half of patients undergoing RC are not eligible to receive perioperative cisplatin-based chemotherapy based on renal function status.About a quarter of patients eligible for cisplatin before surgery are no longer eligible after RC.Certain patient characteristics and surgical factors are more likely to experience a negative change in GFR after RC and should be counselled accordingly.