背景:为了检查不同的估算肾小球滤过率(eGFR)公式和测量的肌酐清除率(CrCI)在肌肉浸润性膀胱癌(MIBC)的初步诊断中的一致性。
方法:我们对MIBC患者进行了多中心分析,以顺铂为基础的新辅助化疗(NAC)和根治性膀胱切除术(RC),或者单独使用RC,2011年至2021年。使用4个计算的血清方程计算基线eGFR,包括Cockcroft-Gault(CG),MDRD,CKD-EPI2009和无种族CKD-EPI2021。为了检查计算的eGFR和测量的CrCI之间的关联,在测定24小时尿CrCl的患者中进行了亚组分析。顺铂不合格定义为CrCI和/或eGFR<60mL/分钟/1.73m2。
结果:在956名患者中,30.0%,33.3%,31.9%,CG发现27.7%的顺铂不合格,MDRD,CKD-EPI,和无种族CKD-EPI方程(P=.052)。计算的eGFR公式之间的一致性被认为是实质性的(Cohen'skappa(k):0.66-0.95)。在测得CrCl的亚组(n=245)中,37例(15.1%)患者的CrCI小于60mL/分钟。测量的CrCl与计算的eGFR之间的一致性较差(:0.29-0.40)。所有计算的eGFR公式都明显低估了测量的CrCI。具体来说,78%-87.5%的eGFR在40至59mL/分钟之间的患者表现出测量的CrCI≥60mL/分钟。
结论:比较计算的eGFR公式,相似百分比的MIBC患者被认为不适合顺铂.然而,根据测得的CrCI,相当数量的患者可以通过顺铂配伍升级,特别是当计算的eGFR在40~59mL/min的灰色范围内时.
BACKGROUND: To examine the agreement of different calculated estimated glomerular filtration rate (eGFR) formulas and measured creatinine clearance (CrCI) at the primary diagnosis of muscle-invasive bladder cancer (MIBC).
METHODS: We performed a multicenter analysis of patients with MIBC, treated with cisplatin-based neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), or with RC alone, between 2011 and 2021. Baseline eGFR was computed using 4 calculated serum equations including Cockcroft-Gault (CG), MDRD, CKD-EPI 2009, and race-free CKD-EPI 2021. To examine the association between calculated eGFR and measured CrCI, subgroup analyses were performed among patients in whom measured 24-hour urine CrCl was determined. Cisplatin-ineligibility was defined as CrCI and/or eGFR < 60 mL/minute per 1.73 m2.
RESULTS: Of 956 patients, 30.0%, 33.3%, 31.9%, and 27.7% were found to be cisplatin-ineligible by the CG, MDRD, CKD-EPI, and race-free CKD-EPI equations (P = .052). The concordance between calculated eGFR formulas was rated substantial (Cohen\'s kappa (k): 0.66-0.95). Among the subgroup (n = 245) with measured CrCl, 37 (15.1%) patients had a CrCI less than 60 mL/minute. Concordance between measured CrCl and calculated eGFR was poor (ĸ: 0.29-0.40). All calculated eGFR formulas markedly underestimated the measured CrCI. Specifically, 78%-87.5% of patients with a calculated eGFR between 40 and 59 mL/minute exhibited a measured CrCI ≥ 60 mL/minute.
CONCLUSIONS: Comparing calculated eGFR formulas, similar percentages of patients with MIBC were deemed cisplatin-ineligible. However, a significant number of patients could be upgraded by being cisplatin-fit based on measured CrCI, particularly when the calculated eGFR was falling within the gray range of 40-59 mL/minute.