Renal Morbidity Following Radical Cystectomy in Patients with Bladder Cancer

Schmidt, Bogdana; Velaer, Kyla N.; Thomas, I‐Chun; Ganesan, Calyani; Song, Shen; Pao, Alan C.; Thong, Alan; Liao, Joseph C.; Chertow, Glenn M.; Skinner, Eila C.; Leppert, John T.

doi:10.1016/j.euros.2021.11.001

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…15 Eisenberg et al reported the first study evaluating renal function with long-term follow up in a large cohort following RC and urinary diversion. 16 They reported that the renal function decline approximately 49% and 72% at 5 and 10 years respectively. In present study also there was decline of renal function in range of 10-1 ml/h eGFR in 61.3% of the patients whereas decline of renal function >10 ml/h eGFR in 3.9% of the patients over 62 months of median follow-up.…”

Section: Discussionmentioning

confidence: 98%

Long term outcomes and impact on renal function following radical cystectomy

Tilala,

Panda,

Tripathi

et al. 2024

Urologia

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Introduction: To assess clinical, oncological outcomes and impact on renal function in patients who underwent the radical cystectomy with pelvic lymphadenectomy for muscle invasive and high risk non-muscle invasive transitional cell carcinoma of urinary bladder without evidence of non-regional lymph nodes and distant metastasis. Materials and methods: With curative intent total 156 patients underwent radical cystectomy with pelvic lymphadenectomy from January 2015 to December 2022. Total 132/156 patients had primary transitional cell carcinoma of bladder. Thirty patients, presented with obstructive nephropathy, operated after stabilization of renal function. Pre-operatively and post-operatively eGFR calculated using modified diet in renal disease formula. Results: In present study 114 (86.36%) patients had high grade TCC, 70 (53.02%) patients had organ confined disease. Nodal extension seen in 74 (56.06%) patients. Perioperative mortality noted in 36 (27.2%) patients. The overall survival and recurrence free survival (RFS) over 5 years was 66.67 and 45.45%. RFS was significantly related to pathological stage, nodal status, histological-grade, positivity of surgical margin and time of surgery from diagnosis. Total 92/132 (69.7%) patients had recurrence. Pelvic recurrence in 10/92 (10.87%) whereas 82/92 (89.13%) patients had distant recurrence. Pre-operatively mean creatinine was 2.6 mg/dl and mean eGFR was 38.9 ml/h in patients who presented with obstructive nephropathy after stabilization of renal function. Post-operatively in 46/132 (34.8%) patients had improvement in eGFR while 86/132 (65.2%) patients had deterioration of eGFR over 62 months of median follow up. Conclusion: Radical cystectomy provides good overall survival outcomes. Pre-operative eGFR has significant impact on post-operative renal function in long term.

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Section: Discussionmentioning

confidence: 98%

Long term outcomes and impact on renal function following radical cystectomy

Tilala,

Panda,

Tripathi

et al. 2024

Urologia

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“…While few studies stratified their analysis of eGFR change by chemotherapy administration, the use of perioperative chemotherapy was frequently examined in multivariable analyses. These revealed an inconsistent relationship with decline in eGFR, [20][21][22][23][24][25][26][27] with the majority not finding a significant relationship (Table 4). This is perhaps unsurprising given the difficulty of adjusting for the multitude of interconnected confounding factors that may affect renal function in patients undergoing RC.…”

Section: Discussionmentioning

confidence: 99%

“…Across several studies, the mean eGFR decline one year post-RC ranged from 2-10 mL/min/1.73 m 2 , with perioperative chemotherapy usage rates varying from 11-41%. [20][21][22][23][24][25][26][27] In a study of 1631 patients where only 12% received perioperative chemotherapy, the mean eGFR decline at one year was 5 mL/min/1.73 m 2 . 22 In a separate study by Chandrasekar et al, 24 the mean eGFR decline of 175 patients who underwent RC without NAC was 1.6 mL/min/1.73 m 2 one year after surgery, whereas it was 19.1 mL/min/1.73 m 2 in the 66 who received cisplatin NAC.…”

Section: Discussionmentioning

confidence: 99%

“…1,19 Independent of cisplatin, RC has been associated with a small but significant long-term decline in renal function. [20][21][22][23][24][25][26][27] While the oncologic effects of NAC and RC have been well-studied, there is a relative paucity of data on the renal impact of combining these two potentially nephrotoxic treatments. The aim of this study was to quantify the impact of combined NAC and RC on patients' renal function.…”

Section: Cua Prize Essaymentioning

confidence: 99%

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The effect of cisplatin-based neoadjuvant chemotherapy on the renal function of patients undergoing radical cystectomy

Ho,

Black,

Zargar

et al. 2023

CUAJ

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INTRODUCTION: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC). Cisplatin, however, can induce renal toxicity. Furthermore, RC is an independent risk factor for renal injury, with decreases in estimated glomerular filtration rate (eGFR) of up to 6 mL/min/1.73 m2 reported at one year postoperatively. Our objective was to evaluate the effect of cisplatin-based NAC and RC on the renal function of patients undergoing both. METHODS: We analyzed a multicenter database of patients with MIBC, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at time points T1 (before NAC), T2 (after NAC but before RC), and T3 (one year post-RC). eGFR and proportion of patients with eGFR <60 ml/min/1.73m2 (chronic kidney disease [CKD] stage ≥3) were compared between these time points. As all patients in this dataset had received NAC, we identified a retrospective cohort of patients from one institution who had undergone RC during the same time period without NAC for context. RESULTS: We identified 234 patients with available renal function data. From T1 to T3, there was a mean decline in eGFR of 17% (13 mL/min/1.73 m2) in the NAC cohort and an increase in proportion of patients with stage ≥3 CKD from 27% to 50%. The parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean baseline eGFR in this cohort was lower than in the NAC cohort (66 vs. 75 mL/min/1.73 m2). The mean eGFR decline in this non-NAC cohort from T1 to T3 was 6% (4 mL/ min/1.73 m2), and the proportion of those with stage ≥3 CKD increased from 37% to 51%. CONCLUSIONS: Administration of NAC prior to RC was associated with a 17% decline in eGFR and a nearly doubled incidence of stage ≥3 CKD at one year after RC. Patients who underwent RC without NAC had a higher rate of stage ≥3 CKD at baseline but appeared to have less renal function loss at one year.

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