662 THE IMPACT OF SURGICAL OR SYSTEMIC THERAPY FOR TESTICULAR GERM CELL MALIGNANCY ON RENAL FUNCTION

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2012662 THE IMPACT OF SURGICAL OR SYSTEMIC THERAPY FOR TESTICULAR GERM CELL MALIGNANCY ON RENAL FUNCTION Nicholas Cost, Mehrad Adibi, Jessica Lubahn, Adam Romman, Ganesh Raj, Arthur Sagalowsky, and Vitaly Margulis Nicholas CostNicholas Cost Dallas, TX More articles by this author , Mehrad AdibiMehrad Adibi Dallas, TX More articles by this author , Jessica LubahnJessica Lubahn Dallas, TX More articles by this author , Adam RommanAdam Romman Dallas, TX More articles by this author , Ganesh RajGanesh Raj Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the good prognosis of patients with testicular germ cell tumors (T-GCTs), the therapy needed to achieve cure may induce long term morbidity. Data from other malignancies suggests that developing chronic kidney disease (CKD) affects long-term renal, cardiovascular and survival outcomes. Thus, we assessed patients treated for T-GCT to determine the effect of therapy on the natural history of renal function. METHODS We reviewed an institutional database of T-GCT patients and included those >13yrs old with available pre and post-therapy serum Creatinine (Cr). We recorded Cr before starting therapy and at last follow-up. Renal function was estimated with a calculated Glomerular Filtration Rate (eGFR). Patients were classified according to CKD staging. We compared those managed with surgery-only to those also treated with chemotherapy (CT). RESULTS 144 patients were reviewed. T-GCT stage distribution was: I-78 (54.2%), II-28 (19.4%) and III-38 (26.4%). The median Cr and eGFR at diagnosis were 0.9 (0.5 to 1.5) and 104.0 (58.7 to 235) respectively. 102 (70.8%) were CKD 0 to I, 41 (28.5%) CKD II and 1 (0.7%) CKD III. The median Cr and eGFR at last followup were 1.0 (0.6 to 2.6), and 95.5 (31.5 to 167.6), respectively. This difference between the pre and post-therapy eGFR was significant, p<0.01. The median eGFR change was -2.1 (-148 to 58). 81 (56.3%) patients received CT, median 4 cycles (1 to 12), and 63 (43.8%) were treated without CT, Table I. We observed that 8 (9.9%) of the CT treated patients developed new-onset CKD III, compared to none in the non-CT group, p=0.01. This increased risk with CT was related to an increasing number of CT cycles with 8.1% of those given 1 to 4 cycles developing CKD III vs. 15.8% of those given >4 cycles, p=0.02. Also, while there was an increase in new-onset CKD III with increasing T-GCT stage (2.6% Stage I, 3.6% Stage II and 13.2% Stage III), this was not statistically significant. CONCLUSIONS Patients with T-GCT treated with CT suffered a significant decrease in eGFR and were at a significantly increased risk of developing CKD III compared to those managed without CT. This is important as we assess for the long-term risks of T-GCT survivorship, and is useful in counseling patients on the risks of therapy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e270 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Cost Dallas, TX More articles by this author Mehrad Adibi Dallas, TX More articles by this author Jessica Lubahn Dallas, TX More articles by this author Adam Romman Dallas, TX More articles by this author Ganesh Raj Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...