Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, (PN), Italy.
Azienda Regionale di Coordinamento per la Salute, Udine, Italy.
BMC Nephrol. 2019 Mar 28;20(1):107. doi: 10.1186/s12882-019-1283-4.
In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy.
A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998-2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs).
During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15-1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42-2.45 for age 40-59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89-10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06-4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46-2.22), oral cavity (SIR = 2.42, 95% CI: 1.36-4.00), and Kaposi's sarcoma (SIR = 10.29, 95% CI: 1.25-37.16).
The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.
在南欧，接受透析治疗的终末期肾病患者的癌症风险尚未得到充分量化。本研究的目的是评估意大利东北部弗留利-威尼斯朱利亚地区透析患者新发恶性肿瘤（DNM）的总体风险模式。
通过当地医疗保健数据库和癌症登记处之间的记录链接，对 3407 名透析患者进行了一项基于人群的队列研究（1998-2013 年）。从首次透析后 30 天到 DNM 诊断、肾移植、死亡、最后一次随访或 2013 年 12 月 31 日的日期计算人年（PYs），以先到者为准。使用标准化发病率比（SIR）和 95%置信区间（CI）来估计与普通人群相比 DNM 的风险。
在 10798PYs 中，330 名透析患者中有 357 名诊断为 DNM。所有 DNM 的风险均高于预期，为 1.3 倍（95%CI：1.15-1.43）。在年轻的透析患者中风险更高（SIR=1.88，95%CI：40-59 岁年龄组为 1.42-2.45），并且随着年龄的增长而降低。此外，在透析开始后的头 3 年内，DNM 风险明显增加，尤其是在第一年（SIR=8.52，95%CI：6.89-10.41）。肾（SIR=3.18；95%CI：2.06-4.69）、皮肤非黑色素瘤（SIR=1.81，95%CI：1.46-2.22）、口腔（SIR=2.42，95%CI：1.36-4.00）和卡波西肉瘤（SIR=10.29，95%CI：1.25-37.16）的 DNM 风险升高。
本文记录的 DNM 风险升高表明需要针对透析患者实施癌症预防和控制的针对性方法。
