1700 THE IMPACT OF RADICAL CYSTECTOMY ON ELIGIBILITY TO RECEIVE PERIOPERATIVE CHEMOTHERAPY BASED ON RENAL FUNCTION

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease II1 Apr 20101700 THE IMPACT OF RADICAL CYSTECTOMY ON ELIGIBILITY TO RECEIVE PERIOPERATIVE CHEMOTHERAPY BASED ON RENAL FUNCTION Rosalia Viterbo, Daniel Canter, Fang Zhu, Megan Oblaczynski, Raffi Berberian, Yu-Ning Wong, David Chen, Richard Greenberg, Robert Uzzo, and Stephen Boorjian Rosalia ViterboRosalia Viterbo More articles by this author , Daniel CanterDaniel Canter More articles by this author , Fang ZhuFang Zhu More articles by this author , Megan OblaczynskiMegan Oblaczynski More articles by this author , Raffi BerberianRaffi Berberian More articles by this author , Yu-Ning WongYu-Ning Wong More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Perioperative chemotherapy has been shown to confer a survival benefit in patients with high-risk invasive bladder cancer. One argument in favor of neoadjuvant treatment has been the potential for radical cystectomy (RC) to preclude receipt of chemotherapy postoperatively. We evaluated the proportion of patients who would be eligible to receive cisplatin-based chemotherapy before and after RC based on renal function. METHODS We reviewed 451 consecutive patients who underwent RC from 2000-2009 to identify 194 patients with cT2-T4 urothelial carcinoma. Serum creatinine immediately before and nadir serum creatinine 1-3 months after surgery were used to calculate creatinine clearance (CrCl) and glomerular filtration rate (GFR). A cutoff CrCl ≥ 60 mL/min or GFR ≥ 60 mL/min/1.73 m2 was used to determine eligibility for chemotherapy. RESULTS Patients were predominantly male (150/194, 77%) and Caucasian (175/194, 90%). Median age was 70.5 years (IQR 63,77) and median preoperative creatinine was 0.90 mg/dL (IQR 0.5,1.3). Fifty-two (27%) had preoperative hydronephrosis, while 180 (93%) underwent an ileal conduit. From the overall cohort, 41% and 33% had inadequate renal function to receive chemotherapy before RC based on CrCl and GFR, respectively (Table). The frequency of inadequate baseline renal function increased significantly with patient age, from 12% of patients <65 to 54% of patients >65 (p<0.0001). RC did not adversely impact the proportion of patients eligible to receive chemotherapy based on renal function, regardless of patient age. In fact, after controlling for preoperative renal function, gender, race, hydronephrosis, and diversion, patients <65 were found to have a 15% increase in CrCl (p<0.001) and an 11% increase in GFR (p=0.004) after surgery. Proportion of Patients Eligible to Receive Neoadjuvant Chemotherapy by Renal Functional Status All patients (n=194) Patients < 65 (n=59) Patients ≥ 65 (n=135) Pre-op Post-op p Pre-op Post-op p Pre-op Post-op p CrCl≥60 114 (59%) 117 (60%) 0.74 52 (88%) 50 (85%) 0.73 62 (46%) 67 (50%) 0.44 GFR≥60 130 (67%) 137 (71%) 0.35 49 (83%) 51 (86%) 0.73 81 (60%) 86 (64%) 0.49 CONCLUSIONS Approximately 40% of patients who would be eligible for neoadjuvant chemotherapy based on pathologic criteria cannot receive cisplatin due to poor baseline renal function. Importantly, surgery does not adversely impact patients' eligibility to receive chemotherapy based on renal function status. Development of effective non-cisplatin containing regimens is therefore required to improve survival, particularly in older patients. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e656 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rosalia Viterbo More articles by this author Daniel Canter More articles by this author Fang Zhu More articles by this author Megan Oblaczynski More articles by this author Raffi Berberian More articles by this author Yu-Ning Wong More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Robert Uzzo More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...