Assessment and Management of Renal Impairment in Chemotherapy for Urogenital Cancer

Kawai, Koji; Ichioka, Daishi; Inai, Hiromu; Miyazaki, Jun; Nishiyama, Hiroyuki

doi:10.1093/jjco/hyt132

Cited by 4 publications

(4 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, there is lack of consensus regarding the accurate identification of patients who may benefit from adjuvant chemotherapy and determine what factors are barriers to systemic therapy eligibility. Renal insufficiency following RNU and nephrotoxic chemotherapy regimen seem to be challenges preventing the effective delivery of cisplatin-based chemotherapy (678). Although general condition and systemic illness could be barriers for perioperative chemotherapy and also significant determinants of survival, the prognostic influences of comorbidity/performance indices on eligibility for adjuvant chemotherapy and survival in patients with UTUC remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

et al. 2017

View full text Add to dashboard Cite

The aim of the present multi-institutional study was to assess the influence of the American Society of Anesthesiologists Physical Status (ASA-PS) classification on adjuvant chemotherapy eligibility and survival in a multi-institutional cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We retrospectively reviewed data from 416 patients who underwent RNU for UTUC at four Korean institutions between 2001 and 2013. The ASA-PS classification was obtained from the anesthesia chart. Locally advanced UTUC was defined as ≥ pT3 and/or pN1 disease. The influence of ASA-PS score on survival was evaluated by Kaplan-Meier analyses and a multivariate Cox regression model. Patients with a higher ASA-PS class were less likely to be eligible for adjuvant chemotherapy in locally advanced UTUC (P = 0.016). Kaplan-Meier estimates showed that the high-risk ASA-PS group has a poorer overallsurvival (OS) and cancer-specific survival (CSS) compared to low risk ASA-PS groups in both the total and locally advanced UTUC cohorts. Based on multivariate Cox regression analysis, the high-risk ASA-PS category was an independent predictor for overall mortality (OM) (hazard ratio [HR], 1.919; 95% confidence interval [CI], 1.017–3.619; P = 0.044) and cancer-specific mortality (CSM) (HR, 2.120; 95% CI, 1.023–4.394; P = 0.043). In conclusion, high-risk ASA-PS score was independently associated with a lower survival rate in patients with UTUC after RNU. However, the influence of ASA-PS classification on survival was limited to locally advanced UTUC. The lower eligibility of patients in the high-risk ASA category for adjuvant chemotherapy may contribute to the lower survival rate in this group.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Considering the underlying systemic disease with predisposition to poor recovery, infectious and cardiorespiratory complications were more common in patients with a high ASA score than in those with a low score. General condition and systemic illness were absolute barriers for systemic chemotherapy and also significant determinants of survival, as for ASA-PS, ranging from a healthy person (class 1) to one with a bad/severe systemic disorder that is a constant threat to life ( 30 ). When the cardiopulmonary system is not strong and working inefficiently, oxygen will not circulate all around the body helping to feed and renew our body tissues and vital organs (liver, kidney, et al.).…”

Section: Discussionmentioning

confidence: 99%

“…Different from other tumor types, renal insufficiency was an unavoidable problem for UTUC patients who underwent RNU. Renal insufficiency often constrains the choice of nephrotoxic chemotherapy regimen, which seems to be a challenge preventing the effective delivery of cisplatin-based chemotherapy ( 30 – 32 ). In this study, similarly, as ASA score increased, the proportion of AC has also risen (10.9%, 20.7%, and 26.9%, respectively, p = 0.003*; Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Influence of American Society of Anesthesiologists Score on Oncologic Outcomes in Patients With Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Large-Sample Study in Two Institutions

et al. 2021

View full text Add to dashboard Cite

IntroductionAs a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU). ASA physical status (ASA-PS) classification not only was found to be associated with increased comorbidities but also independently factors for predicting morbidity and mortality. Accurate risk assessment was being particularly important for patients being considered for surgery.MethodsRecords for 958 patients with UTUC who underwent RNU were reviewed. Clinicopathologic variables, including ASA-PS, were assessed at two institutions. Overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and metastasis-free survival (MFS) were estimated using the Kaplan–Meier method and Cox regression analyses. We measured the independent predictive value of ASA-PS for mortality by multivariate regression. Association of ASA-PS and clinicopathologic variables was assessed.ResultsThe group of patients with ASA = 2/3 had a shorter 5-year OS (67.6% and 49.9%), CSS (72.9% and 58.1%), and MFS (75.1% and 58.5%). The median follow-up time was 39 months. Kaplan–Meier curves showed that the group with ASA = 2/3 had significantly poorer OS, CSS, and MFS. Adjusting for multiple potential confounding factors, multivariate analyses suggested that ASA score was an independent predictor of OS, CSS, and MFS (p = 0.004, p = 0.005, p < 0.001).ConclusionHigher ASA scores were independently associated with lower survival rate. This capability, along with its simplicity, makes it a valuable prognostic metric. It should be seriously referenced in UTUC patients being considered for RNU.

show abstract

“…78 In addition, the U.S. population of cancer survivors is expected to continue to grow as the median age of the population becomes older 79 given that cancer incidence increases with age. 80 Compared to the general population, cancer survivors are at greater risk for several health problems, including kidney disease, 81 heart disease, 82 and diabetes mellitus. 83 Cancer survivors also have elevated risk of developing a new cancer (i.e., second primary cancer) compared to the general population.…”

Section: Introductionmentioning

confidence: 99%

The Role of Policies in Cancer Pain, Health Disparities, and Substance Use

Calvert

2022

SSRN Journal

View full text Add to dashboard Cite

Assessment and Management of Renal Impairment in Chemotherapy for Urogenital Cancer

Cited by 4 publications

References 72 publications

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study

Influence of American Society of Anesthesiologists Score on Oncologic Outcomes in Patients With Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Large-Sample Study in Two Institutions

The Role of Policies in Cancer Pain, Health Disparities, and Substance Use

Contact Info

Product

Resources

About