The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

Matthew D. Ho; Anna J. Black; Homayoun Zargar; Adrian S. Fairey; Laura S. Mertens; Colin P. Dinney; Maria C. Mir; Laura Maria Krabbe; Michael S. Cookson; Niels Erik Jacobsen; Jeffrey S. Montgomery; Evan Y. Yu; Evanguelos Xylinas; Wassim Kassouf; Marc A. Dall‘Era; Nikhil Vasdev; Srikala S. Sridhar; John S. McGrath; Jonathan Aning; Jeff M. Holzbeierlein; Andrew C. Thorpe; Shahrokh F. Shariat; Jonathan L. Wright; Todd M. Morgan; Trinity J. Bivalacqua; Scott North; Daniel A. Barocas; Yair Lotan; Petros Grivas; Andrew J. Stephenson; Jay B. Shah; Bas W. van Rhijn; Siamak Daneshmand; Philippe E. Spiess; Peter C. Black

doi:10.5489/CUAJ.8570

The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

Matthew D. Ho, Anna J. Black, Homayoun Zargar, Adrian S. Fairey, Laura S. Mertens, Colin P. Dinney, Maria C. Mir, Laura Maria Krabbe, Michael S. Cookson, Niels Erik Jacobsen, Jeffrey S. Montgomery, Evan Y. Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A. Dall‘Era, Nikhil Vasdev, Srikala S. Sridhar, John S. McGrath, Jonathan Aning, Jeff M. HolzbeierleinAndrew C. Thorpe, Shahrokh F. Shariat, Jonathan L. Wright, Todd M. Morgan, Trinity J. Bivalacqua, Scott North, Daniel A. Barocas, Yair Lotan, Petros Grivas, Andrew J. Stephenson, Jay B. Shah, Bas W. van Rhijn, Siamak Daneshmand, Philippe E. Spiess, Peter C. Black

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m² reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both. METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m² (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context. RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m²) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m²). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m²), and the proportion of those with stage ≥3 CKD increased from 37% to 51%. CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.

Original language	English (US)
Pages (from-to)	301-309
Number of pages	9
Journal	Journal of the Canadian Urological Association
Volume	17
Issue number	10
DOIs	https://doi.org/10.5489/CUAJ.8570
State	Published - Oct 2023

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Urology

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10.5489/CUAJ.8570

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Ho, M. D., Black, A. J., Zargar, H., Fairey, A. S., Mertens, L. S., Dinney, C. P., Mir, M. C., Krabbe, L. M., Cookson, M. S., Jacobsen, N. E., Montgomery, J. S., Yu, E. Y., Xylinas, E., Kassouf, W., Dall‘Era, M. A., Vasdev, N., Sridhar, S. S., McGrath, J. S., Aning, J., ... Black, P. C. (2023). The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy. Journal of the Canadian Urological Association, 17(10), 301-309. https://doi.org/10.5489/CUAJ.8570

Ho, MD, Black, AJ, Zargar, H, Fairey, AS, Mertens, LS, Dinney, CP, Mir, MC, Krabbe, LM, Cookson, MS, Jacobsen, NE, Montgomery, JS, Yu, EY, Xylinas, E, Kassouf, W, Dall‘Era, MA, Vasdev, N, Sridhar, SS, McGrath, JS, Aning, J, Holzbeierlein, JM, Thorpe, AC, Shariat, SF, Wright, JL, Morgan, TM, Bivalacqua, TJ, North, S, Barocas, DA, Lotan, Y, Grivas, P, Stephenson, AJ, Shah, JB, van Rhijn, BW, Daneshmand, S, Spiess, PE & Black, PC 2023, 'The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy', Journal of the Canadian Urological Association, vol. 17, no. 10, pp. 301-309. https://doi.org/10.5489/CUAJ.8570

@article{72f7af03c38740219d9ab57415245a7c,

title = "The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy",

abstract = "INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m2 reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both. METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m2 (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context. RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m2) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m2). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m2), and the proportion of those with stage ≥3 CKD increased from 37% to 51%. CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.",

author = "Ho, {Matthew D.} and Black, {Anna J.} and Homayoun Zargar and Fairey, {Adrian S.} and Mertens, {Laura S.} and Dinney, {Colin P.} and Mir, {Maria C.} and Krabbe, {Laura Maria} and Cookson, {Michael S.} and Jacobsen, {Niels Erik} and Montgomery, {Jeffrey S.} and Yu, {Evan Y.} and Evanguelos Xylinas and Wassim Kassouf and Dall{\textquoteleft}Era, {Marc A.} and Nikhil Vasdev and Sridhar, {Srikala S.} and McGrath, {John S.} and Jonathan Aning and Holzbeierlein, {Jeff M.} and Thorpe, {Andrew C.} and Shariat, {Shahrokh F.} and Wright, {Jonathan L.} and Morgan, {Todd M.} and Bivalacqua, {Trinity J.} and Scott North and Barocas, {Daniel A.} and Yair Lotan and Petros Grivas and Stephenson, {Andrew J.} and Shah, {Jay B.} and {van Rhijn}, {Bas W.} and Siamak Daneshmand and Spiess, {Philippe E.} and Black, {Peter C.}",

year = "2023",

month = oct,

doi = "10.5489/CUAJ.8570",

language = "English (US)",

volume = "17",

pages = "301--309",

journal = "Journal of the Canadian Urological Association",

issn = "1911-6470",

publisher = "Canadian Medical Association",

number = "10",

}

TY - JOUR

T1 - The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

AU - Ho, Matthew D.

AU - Black, Anna J.

AU - Zargar, Homayoun

AU - Fairey, Adrian S.

AU - Mertens, Laura S.

AU - Dinney, Colin P.

AU - Mir, Maria C.

AU - Krabbe, Laura Maria

AU - Cookson, Michael S.

AU - Jacobsen, Niels Erik

AU - Montgomery, Jeffrey S.

AU - Yu, Evan Y.

AU - Xylinas, Evanguelos

AU - Kassouf, Wassim

AU - Dall‘Era, Marc A.

AU - Vasdev, Nikhil

AU - Sridhar, Srikala S.

AU - McGrath, John S.

AU - Aning, Jonathan

AU - Holzbeierlein, Jeff M.

AU - Thorpe, Andrew C.

AU - Shariat, Shahrokh F.

AU - Wright, Jonathan L.

AU - Morgan, Todd M.

AU - Bivalacqua, Trinity J.

AU - North, Scott

AU - Barocas, Daniel A.

AU - Lotan, Yair

AU - Grivas, Petros

AU - Stephenson, Andrew J.

AU - Shah, Jay B.

AU - van Rhijn, Bas W.

AU - Daneshmand, Siamak

AU - Spiess, Philippe E.

AU - Black, Peter C.

PY - 2023/10

Y1 - 2023/10

N2 - INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m2 reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both. METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m2 (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context. RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m2) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m2). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m2), and the proportion of those with stage ≥3 CKD increased from 37% to 51%. CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.

AB - INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m2 reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both. METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m2 (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context. RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m2) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m2). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m2), and the proportion of those with stage ≥3 CKD increased from 37% to 51%. CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.

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DO - 10.5489/CUAJ.8570

M3 - Article

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JO - Journal of the Canadian Urological Association

JF - Journal of the Canadian Urological Association

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ER -

The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

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