Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder Journal Article

  

Authors:	Dash, A.; Galsky, M. D.; Vickers, A. J.; Serio, A. M.; Koppie, T. M.; Dalbagni, G.; Bochner, B. H.
Article Title:	Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder
Abstract:	BACKGROUND. Perioperative cisplatin-based chemotherapy has shown benefit in patients with high-risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin-based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft-Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl <60 mL/min or GFR <60 mL/min/1.73 m2 was used to determine ineligibility for cisplatin-based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39% were lymph node-positive. The overall proportion of patients ineligible for cisplatin-based chemotherapy was 28% by the CG formula, 52% by Jelliffe, and 24% by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40% of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin-based perioperative chemotherapy in patients with high-risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients. © 2006 American Cancer Society.
Keywords:	aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; cisplatin; patient selection; cancer adjuvant therapy; chemotherapy, adjuvant; creatinine; creatinine blood level; age factors; urinary bladder neoplasms; high risk patient; age; adjuvant chemotherapy; cystectomy; glomerular filtration rate; glomerulus filtration rate; perioperative period; bladder neoplasms; bladder carcinoma; logistic regression analysis; univariate analysis; creatinine clearance; drug indication; calculation; mathematical analysis; kidney function tests; kidney dysfunction; urethral neoplasms; eligibility determination; renal insufficiency; creatinine/blood; cockroft gault formula; jelliffe formula; modification of diet in renal disease formula; urothelial bladder carcinoma
Journal Title:	Cancer
Volume:	107
Issue:	3
ISSN:	0008-543X
Publisher:	Wiley Blackwell
Date Published:	2006-08-01
Start Page:	506
End Page:	513
Language:	English
DOI:	10.1002/cncr.22031
PUBMED:	16773629
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33746298622&partnerID=40&md5=23d4de8c22c76112bae08386a6089039
Notes:	--- - "Cited By (since 1996): 62" - "Export Date: 4 June 2012" - "CODEN: CANCA" - "Source: Scopus"

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