Introduction:

Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for patients with muscle-invasive bladder cancer undergoing radical cystectomy (RC). Cisplatin, however, is known to cause renal injury. 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 post-operatively. 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 multicentre database of patients with muscle-invasive bladder cancer, all of whom received cisplatin-based NAC prior to RC. eGFR values were collected at baseline and 1 year post-RC. eGFR and proportion of patients with eGFR < 60 ml/min/1.73m² (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 our institution who had undergone RC during the same time period without NAC. We collected their eGFR values at the same time points and presented them for illustrative purposes.

Results:

234 patients with available renal function data before NAC and at 1 year post-RC were identified. Over this time period, there was a mean decline in eGFR of 15.4% (11.4 mL/min/1.73 m²) and an increase in proportion of patients with stage ≥ 3 CKD from 27.0% to 50.0%. Our parallel cohort of patients who did not receive NAC was comprised of 236 patients. The mean GFR decline in the non-NAC cohort over the first post-operative year was 7.6% (5.1 mL/min/1.73 m²), and the proportion of those with stage ≥ 3 CKD increased from 36.8% to 50.9%. No statistical comparison was performed between the NAC and non-NAC groups.

Conclusion:

Administration of NAC prior to RC was associated with a 15.4% decline in GFR and a nearly doubled incidence of stage ≥ 3 CKD at 1 year after RC. Control 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.

Funding: N/A