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Impact of acute kidney injury defined by CTCAE v4.0 during first course of cisplatin-based chemotherapy on treatment outcomes in advanced urothelial cancer patients

石塚, 竜太郎 筑波大学 DOI:10.15068/00160535

2020.07.27

概要

Introduction: To clarify the impact of acute kidney injury (AKI) during cisplatin-based chemotherapy on clinical outcome of patients with advanced urothelial cancer (UC).

Methods: I conducted a multicenter retrospective study including 230 UC patients who received gemcitabine and cisplatin (GC) or methotrexate, vinblastine, doxorubicin and cisplatin (MVAC). According to CTCAE v4.0, AKI was defined as an increase of serum creatinine (sCR) level of 0.3 mg/dL or more from baseline.

Results: The median age of patients was 67 yr. One hundred patients received GC; the remaining patients were treated with MVAC or MEC (methotrexate, epirubicin and cisplatin). During the first course of chemotherapy, AKI episodes were observed in 61 patients (26.5%). Pretreatment clinical factors including estimated glomerular filtration rate (eGFR) and creatinine clearance levels calculated using Cockcroft-Gault formula failed to identify a significant predictor for the development of AKI. AKI impacted renal function: at the start of second-course chemotherapy, the average eGFR of patients with AKI was 54.1 ml/min/1.73 m2, significantly lower than that of patients without AKI (63.4 ml/min/1.73 m2). As a result, only 57.4% of patients with AKI received the planned treatment at the second-course. Also, there was a significant difference between the AKI and no-AKI groups in the mean total chemotherapy cycles delivered (2.7 cycles and 3.3 cycles). Survival of patients who developed AKI was significantly worse than that of patients who did not. The 3-year OSs were 10.3% and 21.4%, respectively (P=0.02).

Conclusion: The present study demonstrated that AKI episodes during chemotherapy had a negative impact on both the intensity of subsequent chemotherapy and oncological outcomes.

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