title: Effect of Neoadjuvant Chemotherapy on Renal Function following Radical Cystectomy: Is there a Meaningful Impact?
abstract: Objective:To evaluate the patterns of impact of neoadjuvant chemotherapy (NAC) on renal function across the initial year following treatment for muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC).Methods:We reviewed the charts of 241 patients who underwent RC for urothelial carcinoma of the bladder between 2003-14 at our institution. Renal function was evaluated at multiple time points (pre-chemotherapy, pre-operatively, post-operatively, 6-12 months follow-up), and then classified by CKD staging. Univariable and multivariable logistic regression analyses were performed to determine relationship between NAC and change in CKD stage.Results:Of the 241 patients who underwent RC for urothelial carcinoma of the bladder, 66 (27%) received NAC and 175 (73%) did not. In multivariable analysis, NAC was significantly associated with a decrease of at least one CKD stage from baseline to post-op (p= 0.009), but not to the 6-12 months follow-up time point (p= 0.050). The loss of GFR in the NAC cohort occurs up-front with chemotherapy, but the peri-operative course is similar to those who underwent cystectomy alone. Of the 15 NAC patients (26.8%) who were Stage 3 CKD prior to chemotherapy, none progressed to a higher stage CKD.Conclusion:NAC is associated with an initial decline in GFR, which then remains stable through the first year following RC. Despite an initial insult, patients receiving NAC are not vulnerable to further deterioration. When appropriately selected, NAC does not appear to result in a clinically significant deterioration of renal function.
authors.affiliation: Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto , Toronto, ON, Canada.
authors.forename: Thenappan
authors.initials: T
authors.lastname: Chandrasekar
authors.affiliation: Department of Urology, University of California , Davis, Sacramento, CA, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Pugashetti
authors.affiliation: Department of Public Health Sciences, Division of Biostatistics, University of California Davis , Davis, CA, USA.
authors.forename: Blythe
authors.initials: B
authors.lastname: Durbin-Johnson
authors.affiliation: Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Dall'Era
authors.affiliation: Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Evans
authors.affiliation: Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: deVere White
authors.affiliation: Department of Urology, University of California, Davis, Sacramento, CA, USA; University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Yap
keywords: Urinary bladder neoplasms; acute kidney injury; antineoplastic agents; neoadjuvant therapy; renal insufficiency