慢性血液透析患者的癌症发病率、风险和预后。

Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis.

机构信息

Shanghai Institute of Kidney and Dialysis, Shanghai, China.

Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.

出版信息

Blood Purif. 2020;49(3):310-321. doi: 10.1159/000504243. Epub 2019 Dec 17.

DOI:10.1159/000504243

PMID:31846977

Abstract

BACKGROUND

Information concerning the cancer issue in Chinese patients on hemodialysis (HD) was lacking. Thus, we examined data from our dialysis registry to investigate the incidence of cancer, identify the possible factors, and explore outcomes after cancer diagnosis in patients on chronic HD.

METHODS

A retrospective cohort study of 639 new-onset end-stage renal disease patients who started HD therapy during the period from July 1999 to December 2017 was retrieved from the database in our dialysis center. All eligible patients were followed up until renal transplantation, death, or end of study (March 31, 2019). The definition of a newly diagnosed cancer was that diagnosed 6 months after HD therapy initiation.

RESULTS

Within a median follow-up period of 5.61 years, 58 patients (9.08%) have been diagnosed with cancer with the incidence of 1,494 per 105 person-years. The mean duration from HD initiation to cancer diagnosis was 5.22 ± 3.55 years. Digestive cancer (32.76%) was the most common followed by urologic cancer (18.97%) and lung cancer (15.52%). Advanced age at starting HD therapy (hazard ratio [HR] 1.04) and erythropoietin dosage ≥20,000 U/week (HR 1.95) were independent predictors for cancer occurrence. Of the 256 deaths during the follow-up period, 29 cases (11.33%) were attributed to cancer, with the mortality rate of 717 per 105 person-years. The 1-, 5-, and 10-year cumulative survival rates after cancer diagnosis were 58.73, 34.64, and 20.41%, respectively. A total of 32 patients (55.17%) did not receive any anti-cancer therapy, and the mortality in those patients was significantly increased as compared to patients who received anti-cancer therapy.

CONCLUSION

Cancer is common in HD patients due to the improved survival, and it has a negative effect on patient prognosis. Many patients have failed to receive optimal anti-cancer therapy, which calls for effective communication and cooperation among patients, dialysis unit, and oncology teams.

摘要

背景

缺乏中国血液透析（HD）患者癌症相关信息。因此，我们对透析登记处的数据进行了检查，以调查慢性 HD 患者癌症的发病率，确定可能的因素，并探讨癌症诊断后的结果。

方法

从我们透析中心的数据库中检索了一项回顾性队列研究，纳入了 639 例 1999 年 7 月至 2017 年 12 月期间开始 HD 治疗的新诊断终末期肾病患者。所有符合条件的患者均随访至肾移植、死亡或研究结束（2019 年 3 月 31 日）。新发癌症的定义是在 HD 治疗开始后 6 个月内诊断出的癌症。

结果

中位随访时间为 5.61 年，58 例（9.08%）患者被诊断为癌症，发病率为每 105 人年 1494 例。从开始 HD 到癌症诊断的平均时间为 5.22±3.55 年。消化系统癌症（32.76%）是最常见的，其次是泌尿系统癌症（18.97%）和肺癌（15.52%）。HD 治疗开始时年龄较大（危险比[HR]1.04）和红细胞生成素剂量≥20,000U/周（HR1.95）是癌症发生的独立预测因素。在随访期间的 256 例死亡中，有 29 例（11.33%）归因于癌症，死亡率为每 105 人年 717 例。癌症诊断后 1、5 和 10 年的累积生存率分别为 58.73%、34.64%和 20.41%。共有 32 例（55.17%）患者未接受任何抗癌治疗，这些患者的死亡率明显高于接受抗癌治疗的患者。