The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

Authors

  • Matthew D. Ho Department of Urologic Sciences, University of British Columbia
  • Anna J. Black Department of Urologic Sciences, University of British Columbia
  • Homayoun Zargar Department of Urologic Sciences, University of British Columbia
  • Adrian S. Fairey University of Alberta
  • Laura S. Mertens The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
  • Colin P. Dinney MD Anderson Cancer Center, Houston, TX
  • Maria C. Mir Fundacio Instituto Valenciano de Oncologia, Valencia
  • Laura-Maria Krabbe University of Münster
  • Michael S. Cookson University of Oklahoma College of Medicine, Oklahoma City, OK
  • Niels-Erik Jacobsen University of Alberta
  • Jeffrey S. Montgomery University of Michigan Health System, Ann Arbor, MI
  • Evan Y. Yu University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA
  • Evanguelos Xylinas Weill Cornell Medical College, Presbyterian Hospital, New York, NY
  • Wassim Kassouf McGill University Health Centre
  • Marc A. Dall‘Era University of California at Davis, Davis Medical Center, Sacramento, CA
  • Nikhil Vasdev ertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage
  • Srikala S. Sridhar Princess Margaret Cancer Centre, University of Toronto
  • John S. McGrath Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter
  • Jonathan Aning Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage
  • Jeff M. Holzbeierlein University of Kansas Medical Center, Kansas City, KS
  • Andrew C. Thorpe Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage
  • Shahrokh F. Shariat Weill Cornell Medical College, Presbyterian Hospital, New York, NY
  • Jonathan L. Wright University of Washington, Seattle, WA
  • Todd M. Morgan University of California at Davis, Davis Medical Center, Sacramento, CA
  • Trinity J. Bivalacqua University of Pennsylvania, Philadelphia, PA
  • Scott North Cross Cancer Institute, Edmonton, AB
  • Daniel A. Barocas Vanderbilt University Medical Center, Nashville, TN
  • Yair Lotan University of Texas Southwestern Medical Center, Dallas, TX
  • Petros Grivas University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA
  • Andrew J. Stephenson Rush University, Chicago, IL
  • Jay B. Shah Stanford University, Palo Alto, CA
  • Bas W. van Rhijn The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam
  • Siamak Daneshmand USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA,
  • Philippe E. Spiess H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
  • Peter C. Black Department of Urologic Sciences, University of British Columbia

DOI:

https://doi.org/10.5489/cuaj.8570

Keywords:

cisplatin-based neoadjuvant chemotherapy, radical cystectomy, renal function, kidney cancer

Abstract

INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m2 reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both.

METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m2 (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context.

RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m2) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m2). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m2), and the proportion of those with stage ≥3 CKD increased from 37% to 51%.

CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.

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Published

2023-10-03

How to Cite

Ho, M. . D., Black, A. J. ., Zargar, H. ., Fairey, A. S. ., Mertens, L. S. ., Dinney, C. P. ., Mir, M. C. ., Krabbe, L.-M., Cookson, M. S. ., Jacobsen, N.-E. ., Montgomery, J. S. ., Yu, E. Y. ., Xylinas, E. ., Kassouf, W. ., Dall‘Era, M. A. ., Vasdev, N. ., Sridhar, S. S. ., McGrath, J. S. ., Aning, J. ., Holzbeierlein, J. M. ., Thorpe, A. C. ., Shariat, S. F. ., Wright, J. L. ., Morgan, T. M. ., Bivalacqua, T. J. ., North, S. ., Barocas, D. A. ., Lotan, Y. ., Grivas, P. ., Stephenson, A. J. ., Shah, J. B. ., van Rhijn, B. W. ., Daneshmand, S. ., Spiess, P. E. ., & Black, P. C. . (2023). The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy. Canadian Urological Association Journal, 17(10), 301–9. https://doi.org/10.5489/cuaj.8570

Issue

Vol. 17 No. 10 (2023): CUAJ October

Section

Original Research

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