Baseline Renal Function Status Limits Patient Eligibility to Receive Perioperative Chemotherapy for Invasive Bladder Cancer and Is Minimally Affected by Radical Cystectomy

Abstract

To evaluate the proportion of patients with muscle-invasive urothelial carcinoma (UC) who would be eligible to receive cisplatin-based chemotherapy before and after radical cystectomy based on renal function. We identified 194 consecutive patients who underwent cystectomy for cT2-T4 UC. Serum creatinine (SCr) immediately before and nadir SCr 1-3 months after surgery were used to calculate creatinine clearance (CrCl) and glomerular filtration rate (GFR). A cut-off CrCl ≥ 60 mL/min or GFR ≥ 60 mL/min/1.73 m(2) was used to determine eligibility for chemotherapy. Median patient age was 70.5 years (IQR 63.77) and median preoperative SCr was 1.05 mg/dL (0.9, 1.3). In total, 80/194 (41%) and 64/194 (33%) patients had inadequate renal function to receive chemotherapy before cystectomy based on CrCl and GFR, respectively. The frequency of inadequate baseline renal function increased significantly with patient age, from 12% of patients < 65 to 54% of patients >65 years of age (P < 0.0001). Surgery did not adversely affect the proportion of patients eligible to receive chemotherapy based on renal function, regardless of age. In fact, after controlling for gender, race, preoperative renal function, hydronephrosis, and choice of diversion, patients <65 years of age were found to have a 14% increase in CrCl (P = .01) and an 11% increase in GFR (P = .04) after cystectomy. Approximately 40% of patients who would be candidates for neoadjuvant chemotherapy could not receive cisplatin because of poor renal function. Surgery did not affect patients' eligibility to receive chemotherapy based on renal function status. Development of effective non-cisplatin-based regimens is therefore necessary to optimize survival.