Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients

R. Houston Thompson, Stephen A. Boorjian, Simon P. Kim, John C. Cheville, Prabin Thapa, Robert Tarrel, Roxana S Dronca, Brian Costello, Igor Frank

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Abstract

Objective: • To determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients. Patients and Methods: • Using 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. Results: • The 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 surgery and 387 (50%) had a GFR of <60 mL/min at 3 months after RC. • Patients with hydronephrosis (209 patients) had significantly lower preoperative GFRs than with patients without hydronephrosis (median 52 vs 62 mL/min, respectively; P < 0.001). • Among the 363 patients with a GFR of =60 mL/min before RC, 91 (25%) had a decline in renal function to a GFR of <60 mL/min at 3 months after 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. Conclusions: • Our 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.

Original languageEnglish (US)
JournalBJU International
Volume113
Issue number5 B
DOIs
StatePublished - 2014

Fingerprint

Cystectomy
Cisplatin
Glomerular Filtration Rate
Drug Therapy
Hydronephrosis
Kidney
Urinary Diversion
Chronic Renal Insufficiency
Registries
Linear Models
Epidemiology
Carcinoma

Keywords

  • Cisplatin
  • Cystectomy
  • Glomerular filtration rate
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Thompson, R. H., Boorjian, S. A., Kim, S. P., Cheville, J. C., Thapa, P., Tarrel, R., ... Frank, I. (2014). Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients. BJU International, 113(5 B). https://doi.org/10.1111/bju.12274

Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients. / Thompson, R. Houston; Boorjian, Stephen A.; Kim, Simon P.; Cheville, John C.; Thapa, Prabin; Tarrel, Robert; Dronca, Roxana S; Costello, Brian; Frank, Igor.

In: BJU International, Vol. 113, No. 5 B, 2014.

Research output: Contribution to journalArticle

Thompson, R. Houston ; Boorjian, Stephen A. ; Kim, Simon P. ; Cheville, John C. ; Thapa, Prabin ; Tarrel, Robert ; Dronca, Roxana S ; Costello, Brian ; Frank, Igor. / Eligibility for neoadjuvant/adjuvant cisplatin-based chemotherapy among radical cystectomy patients. In: BJU International. 2014 ; Vol. 113, No. 5 B.
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abstract = "Objective: • To determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients. Patients and Methods: • Using 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. Results: • The 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 surgery and 387 (50{\%}) had a GFR of <60 mL/min at 3 months after RC. • Patients with hydronephrosis (209 patients) had significantly lower preoperative GFRs than with patients without hydronephrosis (median 52 vs 62 mL/min, respectively; P < 0.001). • Among the 363 patients with a GFR of =60 mL/min before RC, 91 (25{\%}) had a decline in renal function to a GFR of <60 mL/min at 3 months after 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. Conclusions: • Our 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.",
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AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Kim, Simon P.

AU - Cheville, John C.

AU - Thapa, Prabin

AU - Tarrel, Robert

AU - Dronca, Roxana S

AU - Costello, Brian

AU - Frank, Igor

PY - 2014

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N2 - Objective: • To determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients. Patients and Methods: • Using 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. Results: • The 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 surgery and 387 (50%) had a GFR of <60 mL/min at 3 months after RC. • Patients with hydronephrosis (209 patients) had significantly lower preoperative GFRs than with patients without hydronephrosis (median 52 vs 62 mL/min, respectively; P < 0.001). • Among the 363 patients with a GFR of =60 mL/min before RC, 91 (25%) had a decline in renal function to a GFR of <60 mL/min at 3 months after 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. Conclusions: • Our 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.

AB - Objective: • To determine renal function eligibility for cisplatin-based chemotherapy using our experience with radical cystectomy (RC) patients. Patients and Methods: • Using 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. Results: • The 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 surgery and 387 (50%) had a GFR of <60 mL/min at 3 months after RC. • Patients with hydronephrosis (209 patients) had significantly lower preoperative GFRs than with patients without hydronephrosis (median 52 vs 62 mL/min, respectively; P < 0.001). • Among the 363 patients with a GFR of =60 mL/min before RC, 91 (25%) had a decline in renal function to a GFR of <60 mL/min at 3 months after 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. Conclusions: • Our 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.

KW - Cisplatin

KW - Cystectomy

KW - Glomerular filtration rate

KW - Urinary bladder neoplasms

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