Peces Ramón, Martínez-Ara Jorge, Miguel José Luis, Arrieta Javier, Costero Olga, Górriz José Luis, Picazo Mari-Luz, Fresno Manuel
Service of Nephrology, Hospital Universitario La Paz, Madrid, Spain.
Nephrol Dial Transplant. 2004 Nov;19(11):2789-96. doi: 10.1093/ndt/gfh458. Epub 2004 Aug 17.
Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation.
We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups.
Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8+/-1.1 vs 2.4+/-0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive.
ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.
长期透析患者易患获得性囊性肾病（ACKD），这可能会导致肾细胞癌（RCC）的发生。目前，在合并肾病的透析前患者中，RCC发生的危险因素尚未明确。本研究的目的是评估合并肾病的透析前患者、慢性透析患者及肾移植患者中RCC的临床病理特征。
我们研究了31例患有RCC及相关肾病患者的32个肾脏。其中，18个肾脏来自17例诊断为RCC时未接受肾脏替代治疗（RRT）的患者；14例患者接受了透析或透析后肾移植。分析并比较了两组患者的多个临床病理特征。
总体而言，男性占多数（75%）；肾硬化是最主要的并存疾病（31%）。透析组和移植组从肾病到RCC的中位间隔时间显著长于透析前组（15.8±1.1年 vs 2.4±0.7年，P<0.0001）。与透析前RCC相比，透析组和移植组RCC中ACKD的发生率更高（100% vs 28%，P<0.0001），乳头状RCC的发生率更高（43% vs 11%，P<0.05），多灶性肿瘤的发生率更高（43% vs 5%，P<0.05）。研究结束时，71%的透析及移植患者和72%的透析前患者存活。
透析患者会发生ACKD，肾病患者在接受RRT前也会发生。肾病的病程似乎是ACKD和RCC的主要决定因素，而非透析过程本身。与无或仅有少量获得性囊肿且肾病病程短的患者相比，ACKD和长期RRT患者发生的RCC更常见乳头状且为多灶性。两组的长期预后无差异。
