[Clinical analysis of renal dysfunction in 59 patients with gynecological malignant tumor during chemotherapy]

Objective: To analysis the patients with gynecological malignant tumor and gynecologic malignant tumor complicated with kidney diseases appeared renal dysfunction during chemotherapy, and protect the residual renal function. Methods: A retrospective analysis of 59 patients with gynecological malignant tumor with abnormal renal function during chemotherapy in Peking University People's Hospital from May 2000 to April 2016. According to whether or not complicated with kidney diseases and renal dysfunction before chemotherapy, all cases were divided into two groups. Group A was the patients without kidney diseases and with normal renal function before chemotherapy (n=35), while group B with kidney disease before chemotherapy (n=24), included 10 cases of normal renal function and 14 cases of abnormal renal function. Results: (1) During chemotherapy there were respectively 24 cases(69%) occurred mild renal dysfunction, 3 cases(9%) of moderate renal dysfunction, 1 case(3%) of severe renal dysfunction, 6 cases (17%) of renal failure, 1 case(3%) of reversible renal dysfunction in group A. While, among 10 cases of normal renal function patients in group B, there were 7 cases(7/10) occurred mild renal dysfunction, 1 case (1/10) of moderate renal dysfunction, 1 case(1/10) of severe renal dysfunction, 1 case(1/10) of renal failure. Among 14 cases with abnormal renal function in group B, there were respectively 1 patient(1/14) who renal dysfunction was from mild to renal failure, 9 cases(9/14) of stable renal function and 4 cases(4/14) of severe renal dysfunction became improved after chemotherapy. (2) Renal dysfunction occurred and the number of chemotherapy course: 45 patients with normal renal function (including 35 cases in group A, 10 cases with normal renal function in group B), there were 11 cases(24%) occurred renal dysfunction after intraperitoneal chemotherapy, 20 cases(44%) occurred in the 1-3 courses of treatment, 10 cases(22%) occurred in the 4- 8 courses, while 4 cases(9%) appeared after 8 courses. Among 14 patients with abnormal renal function before chemotherapy in group B, there were respectively 1 patient(1/14) with renal dysfunction was from mild to renal failure occurred at the third courses of chemotherapy, 9 cases(1/14) of stable renal function, 4 cases(4/14) of severe renal dysfunction became improved from the 1-3 course of chemotherapy. (3) The regimen adjustment of chemotherapy before and after the occurrence of renal dysfunction: 45 patients with normal renal function, the platinum-based chemotherapy regimen were used before the occurrence of renal dysfunction. After renal dysfunction occurred, all the patients were received chemoprotective agent amifostine. Among 44 cases with cisplatin-based chemotherapy, 24 cases of them were replaced with carboplatin or oxaliplatin, 4 cases of them just treated with paclitaxel, 2 cases performed chemotherapy and dialysis sequneced, 7 cases adjusted dosage, while the other cases did not any special treatment because of mild renal dysfunction. Finally, there were 37 cases successfully completed the chemotherapy, while 7 cases could not completed chemotherapy, because renal dysfunction was aggravated or renal failure. The 5 year survival rate of 37 cases was 64.9%, 7 cases that did not completed chemotherapy was 14.3%. Fourteen cases with renal dysfunction in group B, 4 cases of them with mild received cisplatin-based chemotherapy, 6 cases used paclitaxel combined carboplatin regimen, including 2 cases with chemotherapy and dialysis sequenced, 3 cases adjusted dosage paclitaxel, 1 case performed modify FOLFOX regimens chemotherapy (tegafur+oxaliplatin+calcium folinate). All 14 patients were successfully completed chemotherapy. The 5 year survival rate was 57.1%. Conclusions: Chemotherapy drugs, especially for platinum-based regimens could induce acute renal insufficiency, even aggravated or lead to renal failure in patients with gynecological cancer. Therefore, we should pay attention to the prevention and treatment of renal dysfunction in patients with gynecological malignant tumor during chemotherapy, adjustment the chemotherapy regimen in patients with renal dysfunction.