Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro‐ureterectomy
What's known on the subject? and What does the study add? Radical nephroureterectomy (RNU), the standard of care treatment for high‐risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and...
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| Published in | BJU international Vol. 112; no. 4; pp. 453 - 461 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford
Wiley-Blackwell
01.08.2013
Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1464-4096 1464-410X 1464-410X |
| DOI | 10.1111/j.1464-410X.2012.11649.x |
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| Abstract | What's known on the subject? and What does the study add?
Radical nephroureterectomy (RNU), the standard of care treatment for high‐risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies.
The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin‐based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m2, respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin‐based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting.
Objective
To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro‐ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin‐based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.
Patient and Methods
We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007.
The eGFR was calculated at baseline and at 3–6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD‐EP) equations).
Results
The median (interquartile range) eGFR decreased by 18.2 (8–12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m2, which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m2, which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3–pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001).
None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer‐specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m2 (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m2 (P = 0.04) were associated with better overall survival in univariable analyses.
Conclusions
In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer‐specific outcomes after RNU. |
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| AbstractList | What's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m(2) , respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting.
To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.
We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations).
The median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses.
In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU. What's known on the subject? and What does the study add? Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45mL/min/1.73m2, respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting. Objective To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes. Patient and Methods We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations). Results The median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60mL/min/1.73m2, which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45mL/min/1.73m2, which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60mL/min/1.73m2 (P = 0.03) and a postoperative eGFR ≥ 45mL/min/1.73m2 (P = 0.04) were associated with better overall survival in univariable analyses. Conclusions In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU. What's known on the subject? and What does the study add? Radical nephroureterectomy (RNU), the standard of care treatment for high‐risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin‐based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m2, respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin‐based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting. Objective To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro‐ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin‐based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes. Patient and Methods We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3–6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD‐EP) equations). Results The median (interquartile range) eGFR decreased by 18.2 (8–12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m2, which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m2, which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3–pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer‐specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m2 (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m2 (P = 0.04) were associated with better overall survival in univariable analyses. Conclusions In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer‐specific outcomes after RNU. What's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m(2) , respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting.UNLABELLEDWhat's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m(2) , respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting.To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.OBJECTIVETo report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes.We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations).PATIENT AND METHODSWe performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations).The median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses.RESULTSThe median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses.In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU.CONCLUSIONSIn patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU. |
| Author | Weizer, Alon Karakiewicz, Pierre I. Comploj, Evi Pycha, Armin Lotan, Yair Novara, Giacomo Ficarra, Vincenzo Xylinas, Evanguelos Scherr, Douglas S. Trinh, Quoc‐Dien Margulis, Vitaly Montorsi, Francesco Lee, Richard K. Seitz, Christian Roupret, Morgan Raman, Jay D. Rink, Michael Shariat, Shahrokh F. Clozel, Thomas Zerbib, Marc |
| Author_xml | – sequence: 1 givenname: Evanguelos surname: Xylinas fullname: Xylinas, Evanguelos organization: Paris Descartes University – sequence: 2 givenname: Michael surname: Rink fullname: Rink, Michael organization: University Medical Center Hamburg‐Eppendorf – sequence: 3 givenname: Vitaly surname: Margulis fullname: Margulis, Vitaly organization: University of Texas Southwestern Medical Center – sequence: 4 givenname: Thomas surname: Clozel fullname: Clozel, Thomas organization: New York‐Presbyterian Hospital – sequence: 5 givenname: Richard K. surname: Lee fullname: Lee, Richard K. organization: New York‐Presbyterian Hospital – sequence: 6 givenname: Evi surname: Comploj fullname: Comploj, Evi organization: General Hospital of Bolzano – sequence: 7 givenname: Giacomo surname: Novara fullname: Novara, Giacomo organization: University of Padua – sequence: 8 givenname: Jay D. surname: Raman fullname: Raman, Jay D. organization: Penn State Milton S. Hershey Medical Center – sequence: 9 givenname: Yair surname: Lotan fullname: Lotan, Yair organization: University of Texas Southwestern Medical Center – sequence: 10 givenname: Alon surname: Weizer fullname: Weizer, Alon organization: University of Michigan – sequence: 11 givenname: Morgan surname: Roupret fullname: Roupret, Morgan organization: Faculté de Médecine Pierre et Marie Curie – sequence: 12 givenname: Armin surname: Pycha fullname: Pycha, Armin organization: General Hospital of Bolzano – sequence: 13 givenname: Douglas S. surname: Scherr fullname: Scherr, Douglas S. organization: New York‐Presbyterian Hospital – sequence: 14 givenname: Christian surname: Seitz fullname: Seitz, Christian organization: Teaching Hospital of the Medical University of Vienna – sequence: 15 givenname: Vincenzo surname: Ficarra fullname: Ficarra, Vincenzo organization: University of Padua – sequence: 16 givenname: Quoc‐Dien surname: Trinh fullname: Trinh, Quoc‐Dien organization: University of Montreal – sequence: 17 givenname: Pierre I. surname: Karakiewicz fullname: Karakiewicz, Pierre I. organization: University of Montreal – sequence: 18 givenname: Francesco surname: Montorsi fullname: Montorsi, Francesco organization: Vita‐Salute University – sequence: 19 givenname: Marc surname: Zerbib fullname: Zerbib, Marc organization: Paris Descartes University – sequence: 20 givenname: Shahrokh F. surname: Shariat fullname: Shariat, Shahrokh F. organization: New York‐Presbyterian Hospital |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27553185$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/23464979$$D View this record in MEDLINE/PubMed |
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| Keywords | Antineoplastic agent Human Nephrology Urinary system disease Renal function Prognosis Nephroureterectomy upper tract urothelial carcinoma Urinary tract disease Malignant tumor Upper urinary tract transitional cell carcinoma Survival Cisplatin Urology Glomerular filtration rate Alkylating agent Chemotherapy Treatment Surgery radical nephroureterectomy Cancer Platinum II Complexes renal function chemotherapy |
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Radical nephroureterectomy (RNU), the standard of care treatment for high‐risk urothelial carcinoma... What's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma... What's known on the subject? and What does the study add? Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma... |
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| SubjectTerms | Aged Biological and medical sciences Carcinoma, Transitional Cell - drug therapy Carcinoma, Transitional Cell - mortality Carcinoma, Transitional Cell - physiopathology Carcinoma, Transitional Cell - surgery Chemotherapy Female Glomerular Filtration Rate Humans Kidney Function Tests Kidney Neoplasms - drug therapy Kidney Neoplasms - mortality Kidney Neoplasms - physiopathology Kidney Neoplasms - surgery Male Medical sciences Middle Aged Mortality Nephrectomy - methods Nephrology. Urinary tract diseases Patient Selection radical nephroureterectomy renal function Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Survival Rate Tumors of the urinary system upper tract urothelial carcinoma Ureter - surgery Urinary tract. Prostate gland |
| Title | Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro‐ureterectomy |
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