title: Influence of baseline renal function and dose reduction of nephrotoxic chemotherapeutic agents on the outcome of metastatic urothelial carcinoma: a retrospective study.
abstract: OBJECTIVE
  To investigate the influence of baseline renal function and dose reduction of chemotherapeutic agents on the outcome of metastatic urothelial carcinoma patients with renal impairment.
  
  
  METHODS
  A total of 57 patients with metastatic urothelial carcinoma treated by systemic chemotherapy were included in the present study. The 24 h-creatinine clearance was measured before each cycle and dose reduction was carried out according to our guidelines. Patients were divided into two groups according to baseline 24 h-creatinine clearance: fit group (60 mL/min/1.48 m(2) ≤) and unfit group (60 mL/min/1.48 m(2) >). Clinical characteristics and final outcomes were compared between the two groups.
  
  
  RESULTS
  There was no significant difference in the total number of chemotherapy cycles of each patient between the two groups (fit group: median 5; unfit group: median 4; P=0.7466), although dose reduction was carried out significantly more often in the unfit group than in the fit group during treatment (fit group: median 0 cycles; unfit group: median 3.5 cycles; P=0.0016). Overall, the median survival was 16 months. There was a significant survival difference between the two groups (fit group: median 17 months; unfit group: median 10 months; P=0.0419). On multivariate analyses, impaired renal function at the baseline remained an adverse factor (HR 2.27, P=0.01).
  
  
  CONCLUSIONS
  "Unfit" was a poor prognostic factor for metastatic urothelial carcinoma. The dose reduction strategy contributed to continuous treatment in the unfit group. However, its contribution to the prognosis of unfit patients is uncertain.
authors: Department of Urology, Hokkaido University Graduate School of Medicine, Department of Urology, Sapporo, Japan.
authors: Shintaro
authors: S
authors: Maru
authors: Takashige
authors: T
authors: Abe
authors: Nobuo
authors: N
authors: Shinohara
authors: Ataru
authors: A
authors: Sazawa
authors: Satoru
authors: S
authors: Maruyama
authors: Toru
authors: T
authors: Harabayashi
authors: Shin
authors: S
authors: Suzuki
authors: Katsuya
authors: K
authors: Nonomura
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D003404:Creatinine / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000378:metabolism / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D003404:Creatinine