Does perioperative chemotherapy affect renal function after radical nephroureterectomy for upper tract urothelial carcinoma?

PURPOSE: To report the impact of perioperative chemotherapy (PC) on short and mid-term estimated glomerular function rate (eGFR) in patients treated by radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

METHODS

A retrospective multicenter study was conducted in all consecutive UTUC patients treated by RNU with or without PC between 2013 and 2022 in 3 French hospitals. eGFR (CKD-EPI formula) were collected in pre and post-operatively until 24 months after RNU. Pre and post RNU eGFR were compared according to the administration of PC. Univariable and multivariable logistic regression models were used to investigate predictors of eGFR < 60 mL/min/1.73m2 at short-term (6 months after RNU) and mid-term (18–24 months after RNU). Finally, the kidney failure free survival was computed for each group, according to the competing risk of death.

RESULTS

Among 231 RNU, 53 (23%) were treated with PC including 29 (55%) neoadjuvant chemotherapy and 24 (45%) adjuvant chemotherapy. The preoperative median eGFR tended to be higher in the PC group (69.5 vs. 65 mL/min/1.73 m², p = 0.07), with a lower rate of renal failure (20.7% vs. 33.1%, p = 0.04). At mid-term after RNU, the median ΔeGFR compared to preoperative surgery was − 18 mL/min/1.73 m2, similar in PC and non-PC group (p = 0.9). In univariate logistic regression, PC do not show a statistically significant effect on eGFR < 60 ml/min at short (OR = 1.2 95%CI:0.54–2.79, p = 0.7) and mid-term (OR = 1.14 95%CI: 0.48–2.78, p = 0.8). According to the competing risk of death, the three-years kidney failure free survival was 11.8 [3.8; 36.4] % and 14.0 [7.31; 26.9] % for PC and no-PC group, respectively (p = 0.3).

CONCLUSION

Administration of PC was not associated with a decline in renal function within two years following RNU.