J Cancer 2019; 10(22):5332-5338. doi:10.7150/jca.28399 This issue
1. Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
2. Division of Nephrology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
3. Department of Radiation Oncology, Chung-Ang University College of Medicine, Seoul, Korea
4. Division of Pulmonology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
5. Department of Radiation Oncology, Myungji Hospital, Goyang, Korea
6. Department of Nuclear Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Song Ee Park and Jin Ho Hwang Contributed equally to this work.
Purpose: Acute kidney injury (AKI) affects cancer therapy outcome and increases morbidity and mortality in cancer patients. We investigated the incidence, risk factors, and clinical outcomes of AKI caused by palliative chemotherapy in lung cancer patients.
Materials and Methods: Between January 2005 and November 2014, 207 lung cancer patients who had been treated with first-line palliative chemotherapy were enrolled. Renal function was assessed during every cycle of chemotherapy. AKI was defined based on changes in serum creatinine levels as described in the Kidney Disease: Improving Global Outcomes guidelines. Clinical outcomes were evaluated depending on AKI occurrence during the first-line chemotherapy.
Results: Of the 207 patients, 36 (17.4%) experienced AKI. Among the 36 patients who developed AKI during chemotherapy, 33 (91.8%) had AKI stage I. Although 19 patients (52.7%) with AKI during chemotherapy progressed to chronic kidney disease (CKD), no patients were reported to progress to end-stage renal disease (ESRD). The number of chemotherapy cycles was independently associated with chemotherapy-induced AKI in multivariate analysis (OR = 1.71, 95% CI 1.29-2.26, p < 0.001). The median follow-up duration was 83 months. Patients with AKI during chemotherapy (AKI group) showed significantly longer time to treatment failure than patients without AKI (non-AKI group) (4.2 vs. 2.5 months, p < 0.001). However, the median overall survival (11.7 vs. 8.8 months, p = 0.147) and progression-free survival (5.5 vs. 5.2 months, p = 0.347) were not different between the groups.
Conclusions: AKI that developed during chemotherapy was mostly of mild degree and its prognosis was favorable. The occurrence of AKI was associated with the number of chemotherapy cycles administered. AKI did not adversely affect survival of lung cancer patients during chemotherapy.
Keywords: Acute kidney injury (AKI), Lung cancer, Chemotherapy, Incidence, Survival, Risk factor