title: Impact of renal function of patients with advanced urothelial cancer on eligibility for first-line chemotherapy and treatment outcomes.
abstract: OBJECTIVE
  The aim of the study is to clarify the clinical effects of first-line chemotherapy regimens for advanced urothelial cancer on clinical responses and survival of patients grouped by renal function.
  
  
  METHODS
  In this multicenter retrospective cohort study, 345 urothelial cancer patients received systemic chemotherapy for metastatic or unresectable disease in 17 centers (2004-10).
  
  
  RESULTS
  Two hundred and forty-one patients were treated with methotrexate, vinblastine, doxorubicin and cisplatin/methotrexate, epirubicin and cisplatin (n = 136) or gemcitabine and cisplatin (n = 105) followed by carboplatin-based treatments, non-platinum treatments or other regimens. After 2008, gemcitabine and cisplatin was the most frequently used regimen in patients with an estimated glomerular filtration rate < 60 ml/min/1.73 m(2) and in those with estimated glomerular filtration rate ≥ 60 ml/min/1.73 m(2). The gemcitabine and cisplatin patients' complete response rate was 10.5% and their response rate was 52.4%, which was highest among all regimens. Gemcitabine and cisplatin demonstrated a better 3-year overall survival when the estimated glomerular filtration rate was ≥ 60 ml/min/1.73 m(2) (31.4%), but it tended to be worse when the estimated glomerular filtration rate was < 60 ml/min/1.73 m(2) (14.1%). In the latter cases, the dose reduction rate of gemcitabine and cisplatin was high (43.9%). Among the patients with estimated glomerular filtration rate < 60 ml/min/1.73 m(2), the 1-year overall survival of the patients treated with a reduced dose of gemcitabine and cisplatin was significantly lower than that of those treated with standard-dose gemcitabine and cisplatin (26.2 vs. 60.3%, respectively, P = 0.0108).
  
  
  CONCLUSIONS
  Gemcitabine and cisplatin provided favorable responses and survival in patients with estimated glomerular filtration rate ≥ 60 ml/min/1.73 m(2) but unsatisfactory oncological outcomes in patients with estimated glomerular filtration rate < 60 ml/min/1.73 m(2), especially when treated with a reduced dose. Alternative regimens might be optimal rather than reduced-dose gemcitabine and cisplatin in patients with estimated glomerular filtration rate < 60 ml/min/1.73 m(2).
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba.
authors.forename: Daishi
authors.initials: D
authors.lastname: Ichioka
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba.
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: Department of Urology, Akita University Graduate School of Medicine, Akita.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology, Shiga University of Medical Science, Otsu.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kageyama
authors.affiliation: Department of Urology, Faculty of Medicine, Kagawa University, Kagawa.
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Urology, Graduate School of Medicine, Tohoku University, Sendai.
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.affiliation: Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Urology, Hyogo College of Medicine, Hyogo.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Hirakata.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Wakeda
authors.affiliation: Department of Urology, Tokai University School of Medicine, Isehara.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nomoto
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba nishiuro@md.tsukuba.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D016190:Carboplatin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: chemotherapy; cisplatin; eGFR; gemcitabine; renal function; urothelial cancer