CHRONIC KIDNEY DISEASE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: TRENDS IN CHEMOTHERAPY USAGE AND EFFECTS ON SURVIVAL

You have accessJournal of UrologyBladder Cancer: Natural History & Pathophysiology1 Apr 2014MP50-19 CHRONIC KIDNEY DISEASE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER: TRENDS IN CHEMOTHERAPY USAGE AND EFFECTS ON SURVIVAL Gautum Agarwal, Patrick Espiritu, Adam Luchey, Hui-Yi Lin, Binglin Yue, Jorge Lockhart, Julio Powsang, Philippe E. Spiess, Michael Poch, and Wade Sexton Gautum AgarwalGautum Agarwal More articles by this author , Patrick EspirituPatrick Espiritu More articles by this author , Adam LucheyAdam Luchey More articles by this author , Hui-Yi LinHui-Yi Lin More articles by this author , Binglin YueBinglin Yue More articles by this author , Jorge LockhartJorge Lockhart More articles by this author , Julio PowsangJulio Powsang More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Michael PochMichael Poch More articles by this author , and Wade SextonWade Sexton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1140AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The survival of patients undergoing radical cystectomy for the treatment of bladder cancer has been shown to be improved in patients who receive neoadjuvant chemotherapy (NAC). The purpose of this study was to determine the effects of chronic kidney disease (CKD) on the survival and utilization of NAC in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). Methods We performed a single institution, IRB approved, retrospective review of patients who underwent RC for UCB between 2001-2013. Statistical analyses (Kaplan-Meier) were performed controlling for multiple variables including: age, sex, stage of CKD, ASA score, pathologic tumor stage, nodal status, margin status, history of pelvic radiation, and whether the patient received NAC or adjuvant chemotherapy (AC). GFR, calculated using the MDRD equation, was separated into three groups: those with GFR >= 60 (CKD Stage 1 and 2), GFR between 30 and 59 (CKD Stage 3), and GFR <30 (CKD Stage 4 and 5). Results 732 patients were identified; of this group 551 patients had complete clinical and follow-up data available for study inclusion. Median patient age and GFR was 70 years (IQR 63-77) and 66 mL/min/1.73 m2 (IQR 50-81), respectively. Overall survival for our entire patient cohort was 38 months (95% CI 34-49). Patients with CKD stage 3, 4, and 5 had a significantly worse overall survival compared to patients with CKD stages 1 and 2, [Hazard Ratio (HR) of 3.3 (95% CI 2-5.7), p<0.01 for Stage 4-5 and HR 1.5 (95% CI 1.1-2), p<0.01, for CKD stage 3]. Overall 26% of patient's received NAC, and 21% received AC. Patients with CKD stage 4 and 5 were significantly less likely to receive NAC (p=0.032). However there was no difference in the utilization of AC between CKD stage groups, p=0.21. Patients with higher ASA scores were more likely to have CKD stages 4 and 5, p<0.01. Conclusions CKD stage is an independent predictor of overall survival in patients undergoing radical cystectomy for urothelial carcinoma of the bladder. This outcome may be due in part to the decreased utilization of NAC in patients with impaired renal function, however it is also likely related to the increased presence of comorbidities in patients with higher stage CKD. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e501 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gautum Agarwal More articles by this author Patrick Espiritu More articles by this author Adam Luchey More articles by this author Hui-Yi Lin More articles by this author Binglin Yue More articles by this author Jorge Lockhart More articles by this author Julio Powsang More articles by this author Philippe E. Spiess More articles by this author Michael Poch More articles by this author Wade Sexton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...