Acute kidney injury (AKI) during neoadjuvant chemotherapy is associated with worse oncologic outcomes in patients with muscle-invasive bladder cancer (MIBC), investigators reported at the American Society of Clinical Oncology’s 2023  Genitourinary Cancers Symposium in San Francisco, California.

Among 398 patients with MIBC (median age 69 years) who received 2 to 4 cycles of neoadjuvant chemotherapy followed by radical cystectomy, 66 patients (17%) developed AKI.

The AKI group had a significantly lower proportion of patients with less than ypT2 (38% vs 53%) and downstaging (53% vs 69%) compared with the no AKI group, Naoki Fujita, MD, of Hirosaki University Graduate School of Medicine in Hirosaki, Japan, reported on behalf of his team. In adjusted analyses, patients with AKI had a significant 1.6-fold increased risk of recurrence, a 1.7-fold increased risk of cancer-related death, and a 1.8-fold increased risk of all-cause mortality. The investigators adjusted their analyses for age, performance status, cisplatin-based regimen, tumor grade, pathological T stage, pathological lymph-node involvement, and positive surgical margin. The median follow-up period was 62 months.

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“AKI was associated with reduced effects of neoadjuvant chemotherapy and poor oncologic outcomes in patients who underwent radical cystectomy,” Dr Fujita said in an interview. “The AKI group more frequently used cisplatin-based regimens, so these regimens might be a potential risk factor for AKI. Nephrotoxicity is a well-known adverse event in platinum-based chemotherapy. Carboplatin-based regimens might be a potential strategy to reduce neoadjuvant chemotherapy-induced AKI. Clinicians should also pay an attention to preventive protocols, such as hydration.”


Fujita N, Momota M, Hatakeyama S, et al. Impact of neoadjuvant chemotherapy–induced acute kidney injury on oncological outcomes in patients who underwent radical cystectomy: A multicenter retrospective study. ASCO GU 2023, San Francisco, California, February 16-18. Abstract 573.