Institute of Medical Sciences, Department of Public Health, Tzu Chi University, and Department of Internal Medicine, Hualien Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Nephrol Dial Transplant. 2012 Apr;27(4):1585-90. doi: 10.1093/ndt/gfr464. Epub 2011 Aug 22.
An increased incidence of cancer in chronic dialysis patients has not been confirmed in the Chinese population. The aim of this population-based study was to examine the risk of various types of cancers in chronic dialysis patients in Taiwan.
Data of 92 348 chronic dialysis patients extracted from the National Health Institutes Research Database during 1997-2008 were analyzed. Patients newly diagnosed with end-stage renal disease, free of cancer and receiving dialysis for >3 months were eligible for inclusion in the study.
After a mean follow-up of 4.4 years, a new cancer was diagnosed in 4328 chronic dialysis patients. The standardized incidence ratio (SIR) of chronic dialysis patients was 1.4 [95% confidence interval (CI): 1.3-1.4] and annual incidence of cancer was 1.1%. A trend of an increased SIR of cancer was observed in young patients and within the first year of dialysis. Bladder cancer carried the highest SIR (SIR: 8.2, 95% CI: 6.7-9.9) and had the highest frequency (21.2%). Importantly, the frequency (15.3%) of liver cancer was the second highest and the SIR (SIR: 1.4, 95% CI: 1.2-1.5) of liver cancer in chronic dialysis patients was higher than that of their healthy counterparts. Unexpectedly, chronic dialysis patients had a significantly reduced risk of developing lung cancer.
Increased risk of cancer in chronic dialysis patients is confirmed in the Taiwanese population and it is necessary to develop different strategies for cancer screening in chronic dialysis patients among different ethnicities.
癌症在慢性透析患者中的发病率增加在中国人群中尚未得到证实。本基于人群的研究旨在探讨台湾慢性透析患者各种癌症的发病风险。
分析了 1997 年至 2008 年期间从国家健康研究所研究数据库中提取的 92348 名慢性透析患者的数据。符合纳入标准的患者为新诊断为终末期肾病、无癌症且接受透析治疗>3 个月的患者。
在平均 4.4 年的随访后，4328 名慢性透析患者被诊断出患有新癌症。慢性透析患者的标准化发病比（SIR）为 1.4（95%置信区间：1.3-1.4），癌症年发病率为 1.1%。观察到癌症 SIR 呈上升趋势，特别是在年轻患者和透析开始的第一年。膀胱癌的 SIR 最高（SIR：8.2，95%置信区间：6.7-9.9），发病率最高（21.2%）。重要的是，肝癌的发病率（15.3%）位居第二，慢性透析患者肝癌的 SIR（SIR：1.4，95%置信区间：1.2-1.5）高于其健康对照组。出乎意料的是，慢性透析患者患肺癌的风险显著降低。
在台湾人群中证实了慢性透析患者癌症风险增加，有必要针对不同种族的慢性透析患者制定不同的癌症筛查策略。
