639 PREOPERATIVE PREDICTORS OF RENAL FUNCTION DECLINE FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2012639 PREOPERATIVE PREDICTORS OF RENAL FUNCTION DECLINE FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Matthew Kaag, Landon Trost, R. Houston Thompson, Ricardo Favaretto, Vanessa Elliott, Shahrokh Shariat, Ally Maschino, Jay Raman, and Guido Dalbagni Matthew KaagMatthew Kaag Hershey, PA More articles by this author , Landon TrostLandon Trost Rochester, MN More articles by this author , R. Houston ThompsonR. Houston Thompson Rochester, MN More articles by this author , Ricardo FavarettoRicardo Favaretto New York, NY More articles by this author , Vanessa ElliottVanessa Elliott Hershey, PA More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , Ally MaschinoAlly Maschino New York, NY More articles by this author , Jay RamanJay Raman Hershey, PA More articles by this author , and Guido DalbagniGuido Dalbagni New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.718AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) may result in a clinically significant decrease in renal function. This loss of glomerular filtration rate (GFR) may impact the ability to adequately deliver postoperative chemotherapy. We developed a model to predict GFR based on interval from NU, and assessed predictors of GFR after surgery. METHODS We identified 370 patients treated with NU for UTUC at 3 centers between 1995 and 2010 who had post-operative laboratory data. Only patients deemed eligible for cisplatin-based chemotherapy before NU (pre-operative GFR>60 ml/min/m2) were included. We created a generalized estimating equations linear model to predict GFR based on the time from surgery. We used univariate linear regression to identify predictors of GFR after NU at early post-operative (1-5 months after NU) and late post-operative (>5 months after NU) time points. RESULTS 163 patients had an eligible early post-NU GFR measurement and 172 had an eligible late post-NU GFR measurement. The median age was 67 (IQR 59, 73) and 154 (72%) were male. The median GFR prior to NU was 72 ml/min/m2 (IQR 64, 80). When modeling GFR after surgery, we did not see evidence that post-NU GFR values changed significantly over time, despite allowing for a possible non-linear relationship in the model. At 2 months the predicted GFR was 52 ml/min/m2 (95% CI: 51, 54); at 6 months it was 51 ml/min/m2 (95% CI: 49, 53). On univariate analysis, age and preoperative GFR were both significant predictors of early (per year: β= -0.4; 95% CI: -0.6, -0.2; p<0.0005 and per 10 ml/min/m2: β= 5.4; 95% CI: 3.7, 7.2; p<0.0005) and late GFR outcomes (per year: β= -0.4; 95% CI: -0.5, -0.2; p<0.0005 and per 10 ml/min/m2: β= 4.1; 95% CI: 2.6, 5.6; p<0.0005). On multivariate analysis, preoperative GFR and age remained significant predictors of both early (p<0.0005 and p=0.004) and late (p=0.001 and p=0.007) GFR after NU. Charlson score was also an independent predictor of late GFR post-NU on multivariate analysis (p=0.004). CONCLUSIONS Renal function decreases after NU and does not show evidence of recovery over time. Pre-NU GFR and patient age are independent predictors of post-NU GFR at early and late time points, while Charlson score predicts only late post-operative GFR. Diminished GFR following NU is likely to limit utilization of adjuvant cisplatin-based chemotherapy. These data underscore the need for clinical trials evaluating neoadjuvant chemotherapy in well-selected patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e260 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Kaag Hershey, PA More articles by this author Landon Trost Rochester, MN More articles by this author R. Houston Thompson Rochester, MN More articles by this author Ricardo Favaretto New York, NY More articles by this author Vanessa Elliott Hershey, PA More articles by this author Shahrokh Shariat New York, NY More articles by this author Ally Maschino New York, NY More articles by this author Jay Raman Hershey, PA More articles by this author Guido Dalbagni New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...