OBJECTIVES: To model renal function after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
To identify predictors of renal function decline after surgery, thereby allowing identification of patients likely to be ineligible for cisplatin-based chemotherapy in the adjuvant setting.
PATIENTS AND METHODS: We retrospectively identified 374 patients treated with RNU for UTUC at 3 centers between 1995 and 2010. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI before RNU and at early (1-5 months after RNU) and late (>5 months) time-points following RNU. Only patients deemed eligible for cisplatin-based chemotherapy before RNU (pre-operative GFR>60 ml/min/1.73m2 ) were included. Multivariable analysis identified pre-operative predictors of eGFR after RNU at early post-operative and late-postoperative time-points.
RESULTS: 163 patients had an eligible early post-RNU eGFR measurement and 172 had an eligible late eGFR measurement. Median eGFR declined by 32% and did not show a significant trend toward recovery over time (p=0.4). On multivariable analysis pre-operative eGFR and patient age were significantly associated with early and late postoperative eGFR while Charlson score was significantly associated with late post-operative eGFR alone.
CONCLUSION: In patients with normal pre-operative eGFR (>60 ml/min/1.73m2 ), renal function decreases by one-third after RNU and does not show evidence of recovery over time. Elderly patients and those with pre-RNU eGFR closer to 60 ml/min/1.73m2 (lower eGFR in our cohort) are more likely to be ineligible for adjuvant cisplatin-based chemotherapy regimens due to renal functional loss after RNU.
Written by:
Kaag M, Trost L, Thompson RH, Favaretto R, Elliott V, Shariat SF, Maschino A, Vertosick E, Raman JD, Dalbagni G. Are you the author?
Penn State Hershey Medical Center, Hershey, PA 17033.
Reference: BJU Int. 2013 Dec 9. Epub ahead of print.
doi: 10.1111/bju.12597
PubMed Abstract
PMID: 24314050
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