MP67-08 MEDICAL COMORBIDITIES, NOT NEOADJUVANT CHEMOTHERAPY, AFFECTS DECLINE IN RENAL FUNCTION FOLLOWING RADICAL CYSTECTOMY AND ELIGIBILITY FOR PLATINUM BASED ADJUVANT CHEMOTHERAPY (2015)

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-08 MEDICAL COMORBIDITIES, NOT NEOADJUVANT CHEMOTHERAPY, AFFECTS DECLINE IN RENAL FUNCTION FOLLOWING RADICAL CYSTECTOMY AND ELIGIBILITY FOR PLATINUM BASED ADJUVANT CHEMOTHERAPY Mohammed Haseebuddin, Daniel Parker, Zack Piotrowski, Brian Egleston, Nikhil Wainganker, Rosalia Viterbo, Alexander Kutikov, Marc Smaldone, Richard Greenberg, David Chen, and Robert Uzzo Mohammed HaseebuddinMohammed Haseebuddin More articles by this author , Daniel ParkerDaniel Parker More articles by this author , Zack PiotrowskiZack Piotrowski More articles by this author , Brian EglestonBrian Egleston More articles by this author , Nikhil WaingankerNikhil Wainganker More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2491AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite level I evidence showing an improved overall survival in patients undergoing neoadjuvant chemotherapy (NAC), only about 20% of the muscle-invasive bladder cancer (MIBC) patients undergo NAC in the United States. Patients who were eligible for NAC can become ineligible for cisplatin-based adjuvant chemotherapy (AC) if the renal function declines to GFR<50 after radical cystectomy (RC). Here, we sought to determine patient demographic and comorbidity history, including the use of NAC, impacting the decline of renal function to a threshold where platinum based AC is no longer feasible. METHODS 315 patients who underwent RC between 2006 and 2011 were identified from the institutional registry. Eligibility criteria were eGFR>50 preop, and a pathological diagnosis of primary urothelial MIBC. Adjusting for patient variables (age, gender, race), comorbidities (preop anticoagulation, CAD, afib/MI/PE, HTN, DM, DVT), receipt of NAC, intraoperative factors (EBL) and postoperative factors (Length of stay), logistic regressions were used to examine the determinants of eGFR <50 measured anytime within 3 months postoperatively. RESULTS 187 patients met criteria. 57 underwent NAC and 130 patients did not. Of patients without NAC, 39 patients experienced a decline in eGFR<50 (30%). On univariate analysis, presence of DM (OR 2.41, 95% CI 1.07-5.46) and presence of HTN (OR 2.37, 95% CI 1.24-4.53) were the only factors associated with increased risk of GFR decline<50. In a multivariable model, only HTN (OR 2.26, 95% CI 1.05-4.84) was associated with increased risk (TABLE 1). Receipt of NAC was not associated with GFR decline in either adjusted or unadjusted models. CONCLUSIONS NAC is not associated with renal function decline after RC and should be encouraged particularly in patients with normal GFR and medical comorbidities. Up to 30% of patients with normal GFR preoperatively and eligible for NAC may become ineligible for platinum based systemic therapy after RC based on renal function decline. TABLE 1. Multivariate Logistic Model for predicting decline in eGFR<50 Odds Ratio 95% Confidence Interval P-value Age 1 0.97-1.04 0.91 Gender Male - - - Female 1.12 0.50-2.53 0.78 Race White - - - AA 1.29 0.31-5.33 0.72 Other 1.14 0.07-18.17 0.92 Preop Anticoagulation 0.96 0.40-2.29 0.92 Preop CAD 1.64 0.67-4.01 0.28 Preop afib/MI/PE 0.48 0.16-1.43 0.19 Preop HTN 2.26 1.05-4.84 0.04 Preop DM 2.02 0.80-5.08 0.14 Preop DVT 0.91 0.14-6.01 0.92 Neoadjuvant Chemotherapy 1.55 0.73-3.29 0.25 EBL 0.99 0.99-1.00 0.42 Length of hospitalization 1.02 0.99-1.06 0.15 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e852-e853 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammed Haseebuddin More articles by this author Daniel Parker More articles by this author Zack Piotrowski More articles by this author Brian Egleston More articles by this author Nikhil Wainganker More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...