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Ruess, F.
Cisplatin exposure and long-term kidney function trajectories in patients with testicular germ cell tumors
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2025. pp. 81 [OPEN ACCESS]
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Authors Med Uni Graz:
Advisor:: Posch Florian; Terbuch Angelika
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Abstract:: Background & Objective: Platinum-based chemotherapy induces cure in patients with testicular germ cell tumors (TGCT) but may come at the cost of kidney toxicity. In this study, we aimed to quantify the association of type and dose of platinum exposure with long-term kidney function trajectories in TGCT patients. Methods: Sixteen-thousand-nine-hundred-fifty-three longitudinal estimated glomerular filtration rate (eGFR) measurements from 777 TGCT patients were analyzed with time-to-event regression and linear mixed models. Co-primary outcomes were the cumulative incidence of a 30% relative decline in eGFR from pre-treatment eGFR, and the longitudinal annualized absolute change in the eGFR (in ml/min/1.73m²/year). Results: Pre-treatment eGFR was 96ml/min/1.73m². Cumulative 10-year incidences of a 30% decline in eGFR were 18% in patients who never received any platinum-based therapy (Group 1, n=335), 18% in patients treated with single-shot adjuvant carboplatin (Group 2, n=83), 17% in those treated with 1-2 cycles of adjuvant bleomycin/etoposide/cisplatin (BEP, Group 3, n=118), and 35% in those treated with ≥3 cycles of BEP (Group 4, n=241), respectively (Gray’s test p<0.0001). However, time-dependent event rates of a 30% decline in eGFR of these 4 groups were highly similar after 4 years of follow-up. The annualized absolute average changes in eGFR were -0.1ml/min/1.73m²/year, 0.1ml/min/1.73m²/year, -0.5ml/min/1.73m²/year, and -1.5ml/min/1.73m²/year in groups 1-4, respectively. The risk of any haemodialysis after study inclusion was 0%. Conclusion: As compared to TGCT patients without platinum exposure, only patients treated with ≥3 cycles of cisplatin experienced a higher risk of longer-term kidney function decline.