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).
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.
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.
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.
The oncologist. 2024 Jul 02 [Epub ahead of print]
Renate Pichler, Josef Fritz, Andrea Mari, Anna Cadenar, Markus von Deimling, Gautier Marcq, Francesco Del Giudice, Costantino Leonardo, Eugenio Bologna, Keiichiro Mori, Rana Tahbaz, Maria De Santis, Tobias Klatte, Barbara Erber, Felizian Lackner, Andreas Kronbichler, Andreas Seeber, Margit Fisch, Marco Moschini, Benjamin Pradere, Laura S Mertens
Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck 6020, Austria., Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck 6020, Austria., Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg 20249, Germany., Department of Urology, Claude Huriez Hospital, CHU Lille, Lille 59037, France., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome 00185, Italy., Department of Urology, The Jikei University School of Medicine, 105-8461 Tokyo, Japan., Department of Urology, Charité Universitätsmedizin Berlin, Berlin 10117, Germany., Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom., Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck 6020, Austria., Department of Urology, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan 20132, Italy., Department of Urology, La Croix du Sud Hospital, 31130 Quint-Fonsegrives, France., Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1006, The Netherlands.