PMID- 20564402
OWN - NLM
STAT- MEDLINE
DCOM- 20100719
LR  - 20220330
IS  - 0008-543X (Print)
IS  - 0008-543X (Linking)
VI  - 116
IP  - 12
DP  - 2010 Jun 15
TI  - Chronic kidney disease after nephroureterectomy for upper tract urothelial 
      carcinoma and implications for the administration of perioperative chemotherapy.
PG  - 2967-73
LID - 10.1002/cncr.25043 [doi]
AB  - BACKGROUND: The prevalence of chronic kidney disease (CKD) in patients with upper 
      tract urothelial carcinoma (UTUC) is poorly defined, both before and after 
      nephrouretectomy. Although multimodal treatment paradigms for UTUC are 
      under-developed, this has important implications on patients' ability to receive 
      cisplatin-based combination chemotherapy (CBCC). METHODS: Estimated glomerular 
      filtration rate (eGFR) was calculated using the Modification of Diet in Renal 
      Disease formula in 336 patients with UTUC, who were treated at the Cleveland 
      Clinic by nephroureterectomy since 1992. An eGFR cutoff of 60 mL/min/1.73 m(2) 
      was used to determine the presence of CKD and eligibility for CBCC. RESULTS: 
      Median age was 72 years and median preoperative eGFR was 59 mL/min/1.73m(2). 
      Before nephroureterectomy, only 48% of patients were eligible to receive CBCC and 
      this decreased to 22% postoperatively (P < .001). In the 144 patients with 
      pT2-pT4 and/or pN1-pN3 disease who are suitable to receive CBCC, these 
      proportions were 40% and 24%, respectively (P = .009). Although 50 patients 
      overall received some form of perioperative chemotherapy, only 3 and 11 patients 
      received neoadjuvant and adjuvant CBCC, respectively. CONCLUSIONS: CKD is 
      prevalent in the UTUC population and a minority of patients has an optimal eGFR 
      to receive neoadjuvant CBCC. Nephrouretectomy may eliminate CBCC as a therapeutic 
      option in 49% of high-risk patients if it is deferred to the adjuvant setting. 
      Multimodal treatment strategies for UTUC should focus on neoadjuvant 
      chemotherapy, as few patients are eligible for adjuvant CBCC because of the 
      substantial decline in eGFR caused by nephroureterectomy.
FAU - Lane, Brian R
AU  - Lane BR
AD  - Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
FAU - Smith, Armine K
AU  - Smith AK
FAU - Larson, Benjamin T
AU  - Larson BT
FAU - Gong, Michael C
AU  - Gong MC
FAU - Campbell, Steven C
AU  - Campbell SC
FAU - Raghavan, Derek
AU  - Raghavan D
FAU - Dreicer, Robert
AU  - Dreicer R
FAU - Hansel, Donna E
AU  - Hansel DE
FAU - Stephenson, Andrew J
AU  - Stephenson AJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
RN  - 5V9KLZ54CY (Vinblastine)
RN  - 80168379AG (Doxorubicin)
RN  - Q20Q21Q62J (Cisplatin)
RN  - YL5FZ2Y5U1 (Methotrexate)
RN  - M-VAC protocol
SB  - IM
CIN - J Urol. 2011 Feb;185(2):464-5. PMID: 22088623
MH  - Aged
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - *Chemotherapy, Adjuvant
MH  - Cisplatin/therapeutic use
MH  - Combined Modality Therapy
MH  - Doxorubicin/therapeutic use
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Kidney Failure, Chronic/etiology/*prevention & control
MH  - Kidney Neoplasms/drug therapy/mortality/*surgery
MH  - Male
MH  - Methotrexate/therapeutic use
MH  - Middle Aged
MH  - *Neoadjuvant Therapy
MH  - Nephrectomy/*adverse effects
MH  - Ureter/*surgery
MH  - Ureteral Neoplasms/drug therapy/mortality/*surgery
MH  - Vinblastine/therapeutic use
EDAT- 2010/06/22 06:00
MHDA- 2010/07/20 06:00
CRDT- 2010/06/22 06:00
PHST- 2010/06/22 06:00 [entrez]
PHST- 2010/06/22 06:00 [pubmed]
PHST- 2010/07/20 06:00 [medline]
AID - 10.1002/cncr.25043 [doi]
PST - ppublish
SO  - Cancer. 2010 Jun 15;116(12):2967-73. doi: 10.1002/cncr.25043.