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Impact of acute kidney injury defined by CTCAE v4.0 during first course of cisplatin-based chemotherapy on treatment outcomes in advanced urothelial cancer patients

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Abstract

Background

The Kidney Disease: Improving Global Outcomes group (KDIGO) defined acute kidney injury (AKI) as an elevation of serum creatinine (sCR) exceeding 0.3 mg/dl within 48 h. The widely used adverse events criteria for chemotherapy, Common Toxicity Criteria for Adverse Events Version 4.0 (CTCAE v4.0), also defined AKI as sCR exceeding 0.3 mg/dl, but with no provision of a time course. Here, we attempted to clarify the impact of AKI (CTCAE v4.0) during cisplatin-based chemotherapy on clinical outcome of patients with advanced urothelial cancer (UC).

Methods

This multicenter retrospective study included 230 UC patients who received cisplatin-based chemotherapy.

Results

During the first chemotherapy course, AKI (CTCAE v4.0) episodes were observed in 61 patients (26.5 %), whereas only four patients (1.5 %) experienced AKI (KDIGO) episodes. Both the pretreatment estimated glomerular filtration rate (eGFR) and creatinine clearance by Cockcroft–Gault formula were not efficient predictors for the development of AKI (CTCAE v4.0). AKI (CTCAE v4.0) impacted renal function: at the start of second-course chemotherapy, the average eGFR of the patients with AKI (CTCAE v4.0) was 54.1 ml/min/1.73 m2, significantly lower than that of patients without AKI (CTCAE v4.0) (63.4 ml/min/1.73 m2). As a result, only 57.4 % of patients with AKI (CTCAE v4.0) received the planned treatment at the second course. The survival of the patients who developed AKI (CTCAE v4.0) was significantly worse than that of the patients who did not. The 3-year OSs were 10.3 and 21.4 %, respectively (P = 0.02).

Conclusion

The present study demonstrated that AKI (CTCAE v4.0) during chemotherapy had a negative impact on both the intensity of subsequent chemotherapy and oncological outcomes.

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Acknowledgments

This work was supported in part by a Grant-in-Aid for Scientific Research (C) (26462397) and a Grant-in-Aid for Scientific Research (B) (26293349).

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Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Ryutaro Ishitsuka, Jun Miyazaki, Daishi Ichioka, Koji Kawai & Hiroyuki Nishiyama

  2. Department of Urology, Akita University Graduate School of Medicine, Akita, 010-8502, Japan

    Takamitsu Inoue

  3. Department of Urology, Shiga University of Medical Science, Shiga, 522-8522, Japan

    Susumu Kageyama

  4. Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 761-0701, Japan

    Mikio Sugimoto

  5. Department of Urology, Tohoku University, Graduate School of Medicine, Miyagi, 980-8575, Japan

    Koji Mitsuzuka

  6. Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan

    Yoshiyuki Matsui

  7. Department of Urology, Hyogo College of Medicine, Hyogo, 663-8501, Japan

    Yusuke Shiraishi

  8. Department of Urology and Andrology, Kansai Medical University, Osaka, 573-1191, Japan

    Hidefumi Kinoshita

  9. Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan

    Hironobu Wakeda

  10. Department of Urology, Tokai University School of Medicine, Kanagawa, 259-1193, Japan

    Takeshi Nomoto

  11. Department of Urology, Keio University School of Medicine, Tokyo, 160-8582, Japan

    Eiji Kikuchi

Authors
  1. Ryutaro Ishitsuka
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  2. Jun Miyazaki
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  3. Daishi Ichioka
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  4. Takamitsu Inoue
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  5. Susumu Kageyama
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  6. Mikio Sugimoto
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  7. Koji Mitsuzuka
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  8. Yoshiyuki Matsui
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  9. Yusuke Shiraishi
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  10. Hidefumi Kinoshita
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  11. Hironobu Wakeda
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  12. Takeshi Nomoto
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  13. Eiji Kikuchi
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  14. Koji Kawai
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  15. Hiroyuki Nishiyama
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Corresponding author

Correspondence to Hiroyuki Nishiyama.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted (IRB approval number H23-33) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent as opt-out was obtained from all individual participants included in the study.

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Cite this article

Ishitsuka, R., Miyazaki, J., Ichioka, D. et al. Impact of acute kidney injury defined by CTCAE v4.0 during first course of cisplatin-based chemotherapy on treatment outcomes in advanced urothelial cancer patients. Clin Exp Nephrol 21, 732–740 (2017). https://doi.org/10.1007/s10157-016-1327-z

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  • DOI: https://doi.org/10.1007/s10157-016-1327-z

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