Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder

Atreya Dash, Matthew D. Galsky, Andrew J. Vickers, Angel M. Serio, Theresa Koppie, Guido Dalbagni, Bernard H. Bochner

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

BACKGROUND. Perioperative cisplatin-based chemotherapy has shown benefit in patients with high-risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin-based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft-Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl 2 was used to determine ineligibility for cisplatin-based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39% were lymph node-positive. The overall proportion of patients ineligible for cisplatin-based chemotherapy was 28% by the CG formula, 52% by Jelliffe, and 24% by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40% of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin-based perioperative chemotherapy in patients with high-risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients.

Original languageEnglish (US)
Pages (from-to)506-513
Number of pages8
JournalCancer
Volume107
Issue number3
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Fingerprint

Cisplatin
Urinary Bladder
Carcinoma
Kidney
Drug Therapy
Creatinine
Urinary Bladder Neoplasms
Diet Therapy
Cystectomy
Glomerular Filtration Rate
Serum
Patient Selection
Renal Insufficiency
Linear Models
Logistic Models
Lymph Nodes

Keywords

  • Adjuvant chemotherapy
  • Aged
  • Bladder neoplasms
  • Creatinine/blood
  • Cystectomy
  • Glomerular filtration rate
  • Kidney function tests

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Dash, A., Galsky, M. D., Vickers, A. J., Serio, A. M., Koppie, T., Dalbagni, G., & Bochner, B. H. (2006). Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer, 107(3), 506-513. https://doi.org/10.1002/cncr.22031

Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. / Dash, Atreya; Galsky, Matthew D.; Vickers, Andrew J.; Serio, Angel M.; Koppie, Theresa; Dalbagni, Guido; Bochner, Bernard H.

In: Cancer, Vol. 107, No. 3, 01.08.2006, p. 506-513.

Research output: Contribution to journalArticle

Dash, A, Galsky, MD, Vickers, AJ, Serio, AM, Koppie, T, Dalbagni, G & Bochner, BH 2006, 'Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder', Cancer, vol. 107, no. 3, pp. 506-513. https://doi.org/10.1002/cncr.22031
Dash, Atreya ; Galsky, Matthew D. ; Vickers, Andrew J. ; Serio, Angel M. ; Koppie, Theresa ; Dalbagni, Guido ; Bochner, Bernard H. / Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. In: Cancer. 2006 ; Vol. 107, No. 3. pp. 506-513.
@article{f584513b714b42eaa2780f14cf682354,
title = "Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder",
abstract = "BACKGROUND. Perioperative cisplatin-based chemotherapy has shown benefit in patients with high-risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin-based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft-Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl 2 was used to determine ineligibility for cisplatin-based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39{\%} were lymph node-positive. The overall proportion of patients ineligible for cisplatin-based chemotherapy was 28{\%} by the CG formula, 52{\%} by Jelliffe, and 24{\%} by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40{\%} of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin-based perioperative chemotherapy in patients with high-risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients.",
keywords = "Adjuvant chemotherapy, Aged, Bladder neoplasms, Creatinine/blood, Cystectomy, Glomerular filtration rate, Kidney function tests",
author = "Atreya Dash and Galsky, {Matthew D.} and Vickers, {Andrew J.} and Serio, {Angel M.} and Theresa Koppie and Guido Dalbagni and Bochner, {Bernard H.}",
year = "2006",
month = "8",
day = "1",
doi = "10.1002/cncr.22031",
language = "English (US)",
volume = "107",
pages = "506--513",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder

AU - Dash, Atreya

AU - Galsky, Matthew D.

AU - Vickers, Andrew J.

AU - Serio, Angel M.

AU - Koppie, Theresa

AU - Dalbagni, Guido

AU - Bochner, Bernard H.

PY - 2006/8/1

Y1 - 2006/8/1

N2 - BACKGROUND. Perioperative cisplatin-based chemotherapy has shown benefit in patients with high-risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin-based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft-Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl 2 was used to determine ineligibility for cisplatin-based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39% were lymph node-positive. The overall proportion of patients ineligible for cisplatin-based chemotherapy was 28% by the CG formula, 52% by Jelliffe, and 24% by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40% of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin-based perioperative chemotherapy in patients with high-risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients.

AB - BACKGROUND. Perioperative cisplatin-based chemotherapy has shown benefit in patients with high-risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin-based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft-Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl 2 was used to determine ineligibility for cisplatin-based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39% were lymph node-positive. The overall proportion of patients ineligible for cisplatin-based chemotherapy was 28% by the CG formula, 52% by Jelliffe, and 24% by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40% of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin-based perioperative chemotherapy in patients with high-risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients.

KW - Adjuvant chemotherapy

KW - Aged

KW - Bladder neoplasms

KW - Creatinine/blood

KW - Cystectomy

KW - Glomerular filtration rate

KW - Kidney function tests

UR - http://www.scopus.com/inward/record.url?scp=33746298622&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33746298622&partnerID=8YFLogxK

U2 - 10.1002/cncr.22031

DO - 10.1002/cncr.22031

M3 - Article

C2 - 16773629

AN - SCOPUS:33746298622

VL - 107

SP - 506

EP - 513

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 3

ER -