title: Risk factors associated with ineligibility of adjuvant cisplatin-based chemotherapy after nephroureterectomy.
abstract: OBJECTIVE
  Radical nephroureterectomy (RNU) is a standard treatment for upper urinary tract urothelial carcinoma. However, RNU can result in decreased renal function and cannot be treated with adjuvant chemotherapy. We performed a risk group stratification analysis to determine the preoperative factors that are predictive of diminished renal function after RNU.
  
  
  METHODS
  We retrospectively evaluated the medical records of all patients who underwent nephroureterectomy for upper urinary tract urothelial carcinoma at the Chang Gung Memorial Hospital from 2001 to 2008. We analyzed the association between perioperative glomerular filtration rate and preoperative parameters including cancer characteristics, serum creatinine level, and kidney size measured on computed tomographic images.
  
  
  RESULTS
  A total of 242 patients fulfilled the inclusion criteria. The average decrease in renal function 1 month after RNU was 19.7%. Using 60 mL/min/1.73 m(2) as the eligibility cutoff for cisplatin-based chemotherapy, 42.1% of the population was eligible prior to nephroureterectomy, whereas following surgery only 15.2% remained eligible. Using a cutoff of 45 mL/min/1.73 m(2), 59.9% of the cohort was eligible for fractionated cisplatin dosing preoperatively, whereas only 32.6% remained above the cutoff postoperatively. The most significant predictors of poor postoperative renal function were body mass index >25 kg/m(2), age >65 years, contralateral kidney length less than 10 cm, and absence of ipsilateral hydronephrosis.
  
  
  CONCLUSIONS
  Our results suggest that older age, higher body mass index, smaller contralateral renal length, and absence of ipsilateral hydronephrosis are predictive of decreased renal function after RNU.
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Department of Urology, Lotung Poh-Ai Hospital, Chang Gung University, Taiwan, Republic of China.
authors.forename: I-Hung
authors.initials: IH
authors.lastname: Shao
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China.
authors.forename: Chen-Pang
authors.initials: CP
authors.lastname: Hou
authors.affiliation: Department of Anatomy, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Horng-Heng
authors.initials: HH
authors.lastname: Juang
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China.
authors.forename: Chien-Lun
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Phei-Lang
authors.initials: PL
authors.lastname: Chang
authors.affiliation: Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Ke-Hung
authors.initials: KH
authors.lastname: Tsui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors; D014516:Ureteral Neoplasms / Q000473:pathology / Q000628:therapy*; D014551:Urinary Tract / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: adjuvant chemotherapy; carcinoma; kidney; transitional cell; upper tract urothelial carcinoma