Nguyen Kevin A, Syed Jamil S, Luciano Randy, Shuch Brian, Vourganti Srinivas
Department of Urology, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, Division of Nephrology, Yale School of Medicine, New Haven, CT, USA.
Nephrol Dial Transplant. 2017 Oct 1;32(10):1767-1773. doi: 10.1093/ndt/gfx254.
For potential transplant recipients with a prior history of renal malignancy, no evidence-based recommendations currently exist with regard to waiting duration on dialysis. We aim to improve decision making by evaluating the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation.
The United States Renal Data System was used to identify patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007. Evaluation of overall survival (OS) was performed with Kaplan-Meier estimates and Cox proportional hazards models. Fine-Gray competing risk models were used to assess cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM).
Of 1 374 175 patients with ESRD, 228 984 (16.7%) received transplantation. Transplant recipients with renal malignancy-associated ESRD (RM-ESRD) had longer waiting durations than those with other known causes of ESRD (2.4 versus 1.3 years; P < 0.0001). RM-ESRD patients who had shorter waiting durations (0-2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P < 0.0001), with similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P = 0.883), whereas NCSM was worse for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P < 0.0001). On Cox modeling, the status of RM-ESRD was not a significant predictor (P = 0.07), while longer waiting duration remained significant (P < 0.0001).
We found that CSM was not affected by waiting duration, while NCSM significantly improved with shorter wait times. These findings suggest that the OS of potential transplant recipients with RM-ESRD may be improved by reducing waiting duration.
对于有肾恶性肿瘤病史的潜在移植受者，目前尚无关于透析等待时间的循证推荐。我们旨在通过评估等待时间对等待肾移植的肾癌患者结局的影响来改善决策。
利用美国肾脏数据系统识别1983年至2007年期间已知终末期肾病（ESRD）病因的患者。采用Kaplan-Meier估计法和Cox比例风险模型评估总生存期（OS）。使用Fine-Gray竞争风险模型评估癌症特异性死亡率（CSM）和非癌症特异性死亡率（NCSM）。
在1374175例ESRD患者中，228984例（16.7%）接受了移植。与肾恶性肿瘤相关的ESRD（RM-ESRD）移植受者的等待时间比其他已知ESRD病因的患者更长（2.年对1.3年；P<0.0001）。等待时间较短（0至2年）的RM-ESRD患者的OS优于等待时间较长（2年以上）的患者（10年OS分别为69.0%对46.7%；P < 0.0001），CSM相似（10年CSM分别为10.3%对10.2%；P = 0.883），而等待时间较长的患者NCSM更差（10年NCSM分别为20.7%对44.3%；P < 0.0001）。在Cox模型中，RM-ESRD状态不是显著预测因素（P = 0.07），而较长的等待时间仍然显著（P < 0.0001）。
我们发现CSM不受等待时间影响，而NCSM随着等待时间缩短显著改善。这些发现表明，通过缩短等待时间可能改善RM-ESRD潜在移植受者的OS。
