Kompotiatis Panagiotis, Thongprayoon Charat, Manohar Sandhya, Cheungpasitporn Wisit, Gonzalez Suarez Maria L, Craici Iasmina M, Mao Michael A, Herrmann Sandra M
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA.
Nephrology (Carlton). 2019 Jan;24(1):65-73. doi: 10.1111/nep.13209.
Previous studies have suggested a higher incidence of urologic malignancies in end-stage renal disease (ESRD) patients. However, incidence trends of urologic malignancies in ESRD patients remain unclear. The aims of the present study were: (i) to investigate the pooled incidence/incidence trends; and (ii) to assess the risk of urologic malignancies in ESRD patients.
A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through April 2017. Studies that reported incidence or odds ratios of urologic malignancies among ESRD patients were included. Pooled odds ratios (OR) and 95%CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017067687).
Nineteen observational studies with 1 931 073 ESRD patients were enrolled. The pooled estimated incidence of kidney cancer and urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) in ESRD patients were 0.3% (95%CI: 0.2-0.5%) and 0.5% (95%CI: 0.3-0.8%), respectively. Meta-regression showed significant positive correlation between incidence of urologic malignancies in ESRD patients and year of study (slopes = +0.05 and +0.07, P < 0.001 for kidney cancer and urothelial cancers, respectively). Compared to non-ESRD status, ESRD was significantly associated with both kidney cancer (pooled OR 6.04; 95% CI 4.70-7.77) and urothelial cancers (pooled OR 4.37; 95% CI 2.40-7.96).
Our study demonstrates a significant association between ESRD and urologic malignancies. The overall estimated incidence rates of kidney cancer and urothelial cancers are 0.4% and 0.5%, respectively. There is a significant positive correlation between the incidence of urologic malignancies and year of study.
既往研究提示终末期肾病（ESRD）患者泌尿系统恶性肿瘤的发病率较高。然而，ESRD患者泌尿系统恶性肿瘤的发病趋势仍不明确。本研究的目的是：（i）调查汇总发病率/发病趋势；（ii）评估ESRD患者发生泌尿系统恶性肿瘤的风险。
使用MEDLINE、EMBASE和Cochrane数据库从建库至2017年4月进行文献检索。纳入报告ESRD患者泌尿系统恶性肿瘤发病率或比值比的研究。采用随机效应模型计算汇总比值比（OR）和95%置信区间（CI）。本荟萃分析的方案已在PROSPERO（国际系统评价前瞻性注册库；编号CRD42017067687）注册。
纳入19项观察性研究，共1931073例ESRD患者。ESRD患者肾癌和尿路上皮癌（膀胱癌、输尿管癌和肾盂癌）的汇总估计发病率分别为0.3%（95%CI：0.2 - 0.5%）和0.5%（95%CI：0.3 - 0.8%）。Meta回归显示ESRD患者泌尿系统恶性肿瘤发病率与研究年份之间存在显著正相关（斜率分别为+0.05和+0.07，肾癌和尿路上皮癌的P值均<0.001）。与非ESRD状态相比，ESRD与肾癌（汇总OR 6.04；95%CI 4.70 - 7.77）和尿路上皮癌（汇总OR 4.37；95%CI 2.40 - 7.96）均显著相关。
我们的研究表明ESRD与泌尿系统恶性肿瘤之间存在显著关联。肾癌和尿路上皮癌的总体估计发病率分别为0.4%和0.5%。泌尿系统恶性肿瘤发病率与研究年份之间存在显著正相关。
