대한신장학회

논문분류	춘계학술대회 초록집
제목	Clinical Outcomes after First-line Palliative Chemotherapy in Lung Cancer According to the Occurrence of Acute Kidney Injury
저자	Jin Ho Hwang* 1, Song Ee Park1, Jin Hwa Choi2, Jung Soon Jang1, Su-Hyun Kim1, In Gyu Hwang1
출판정보	2016; 2016(1):
키워드	Acute kidney injury, clinical outcome, lung cancer, palliative chemotherapy
초록	Background: Acute kidney injury (AKI) is commonly encountered complication after palliative chemotherapy for advanced non-small cell lung cancer (NSCLC, stage IIIB-stage IV) and extensive-stage small cell lung cancer (ES-SCLC). However, reports on clinical outcomes after palliative chemotherapy in lung cancer according to the occurrence of AKI are limited. Here, we investigated the incidence of AKI during and after the 1st line palliative chemotherapy, and its effect on clinical outcomes. Methods: Between Jan. 2005 and Nov. 2014, a total of 485 patients of lung cancer were reviewed and 207 patients were finally enrolled. The AKI was defined by serum creatinine change as described in the Kidney Disease Improving Global Outcomes Guideline. The clinical outcomes were evaluated by the AKI during the chemotherapy, AKI after the chemotherapy, and AKI during the total follow-up period, respectively. Results: In total of the 207 patients, 32 (15.5%) developed AKI. The incidence of AKI was not different between age <65 (15.1%) and age ≥ 65 (15.6%). The occurrence of AKI during the 1st line palliative chemotherapy did not affect to none of the all-cause mortality, progression free survival (PFS), and treatment delay. Treatment failure was occurred more in patients without AKI during the chemotherapy (P=0.003). All-cause mortality occurred significantly more in the patients with AKI after chemotherapy (P<0.001), and was dependent by AKI stage. In multivariate analysis, age (HR 1.028 per 1 year-old increase, P=0.03), lung cancer stage (HR 2.963, P=0.003 for NSCLC stage IV; HR 3.354, P=0.002 for SCLC vs. NSCLC IIIB), disease progression after 1st line palliative chemotherapy (HR 17.555, P=0.005), and AKI after chemotherapy (HR 2.19, P=0.005 for stage II; HR 2.195, P=0.021 vs. no AKI). The PFS was also occurred more in advanced stage of AKI stage after chemotherapy (P=0.029). The patients who experienced AKI during the total follow-up duration showed higher mortality than the others (P=0.01), especially in subgroup of age ≥ 65 (P=0.02). Favorable responses to chemotherapy (complete remission and partial remission) were shown more in patients with AKI during chemotherapy. Conclusion: The AKI during the 1st line palliative chemotherapy did not adversely affect to clinical outcomes and delivery of chemotherapy. The AKI after the chemotherapy related with increased mortality and disease progression. The patients who experienced AKI during the total follow-up duration showed higher mortality than the others. Mortality by AKI was more prominent in old-age patients.
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