Cisplatin-based chemotherapy-induced nephrotoxicity and its impact on the survival status of patients with gynecological cancer in Ethiopia: A multicenter retrospective cohort study

Abstract

Background

Cisplatin-based chemotherapy regimen associated nephrotoxicity is a significant adverse effect that restricts the standard dose of cisplatin by impairing renal function. There is a lack of data on cisplatin-based chemotherapy-induced nephrotoxicity (CIN) in Ethiopian patients with gynecological cancer. This study evaluated the factors associated with CIN and its impact on the survival status of patients with gynecological cancer at Northwest Ethiopia oncology centers.

Methods

This institutional-based retrospective cohort study included patients with gynecological cancer who received cisplatin-based chemotherapy between 2020 and 2021 at Northwest Ethiopia oncology centers. CIN was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 4 criteria and Kidney Disease Improving Global Outcomes (KDIGO) Guideline. A logistic regression model was used to identify the factors associated with CIN. The Cox proportional hazards regression model was used to determine the impact of CIN onpatients survival. The cutoff point was a P value of < 0.05 for declaring statistical significance.

Results

A total of 394 patients with gynecological cancer were included in the final analysis. The incidence of CIN was 27.9 % (95 % CI 23.4,32.7). Old age (≥60 years) [adjusted odds ratio (AOR)=1.7,95 % confidence interval (CI) (1.1–2.9); P=0.039],low serum albumin (<3.5mg/dl)[AOR =2.2,95 %CI (1.3–3.9), P= 0.004], and high dose of cisplatin (>50 mg/m²) [AOR=2.6,95 % CI (1.4–4.7), P=0.002]were significantly associated with CIN.CIN[(adjusted hazard ratio (AHR)=3.2,95 % CI (2.7–9.5), P=0.004]and cisplatin dose reduction [AHR=2.7,95 % CI (1.7–4.3) P=0.021] were significant factors of death among patients with gynecological cancer.

Conclusion

More than a quarter of patients receiving cisplatin-based chemotherapy developed CIN, which negatively affected their survival. This study recommends that prescribers pay special attention to patients with older age, lower serum albumin levels, and high-dose cisplatin to improve renal function and survival. Cisplatin-based chemotherapy-induced nephrotoxicity significantly affects the survival of gynecological cancer patients.