Biostatistical Consulting and Research Laboratory, Medical Research Coordinating Center, Hanyang University, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Korean J Intern Med. 2020 Sep;35(5):1210-1219. doi: 10.3904/kjim.2018.400. Epub 2020 Feb 20.
BACKGROUND/AIMS: The aim of this study was to investigate incidence, survival, and risk factors of cancer in end-stage renal disease (ESRD) patients with hemodialysis using information from the National Health Information Database (NHID).
Using the NHID, we identified ESRD patients who started maintenance hemodialysis between 2003 and 2005 in Korea. Patients were followed from initiation of hemodialysis to renal transplantation, death, or December 31, 2016, whichever came first. We calculated the incidence, survival, and risk factors of cancer.
Of the total 14,382 ESRD patients, 1,124 (7.82%; men:women, 728:396) were diagnosed with cancer during follow-up. The mean duration from the start of hemodialysis to new cancer identification was 64.40 ± 41.81 months. Significant risk factors for the development of new cancer were old age, male sex, and liver disease. Conversely, patients with diabetes showed low risk for new cancer. The colorectum (17.31%) was the most common primary site of cancer in men, followed by the liver (15.8%), stomach (14.29%), lung (13.6%), and kidney (10.3%). In women, the colorectum (14.65%) was also the most common primary site of cancer, followed by the breast (12.88%), thyroid (12.63%), stomach (10.86%), and lung (8.08%). According to the primary site of cancer, breast cancer showed the longest median survival duration (130.93 months), followed by thyroid, kidney, colorectum, bladder, stomach, liver, and lung cancer. On multivariate analyses, overall survival was affected by age and diabetes.
The cancer incidence of chronic hemodialysis patients was relatively high. Thus, careful monitoring and a specific cancer screening program are needed for chronic hemodialysis patients.
背景/目的：本研究旨在利用国家健康资讯数据库（NHID）的信息，调查使用血液透析治疗的终末期肾病（ESRD）患者的癌症发病率、存活率和风险因素。
利用 NHID，我们确定了 2003 年至 2005 年期间在韩国开始维持性血液透析的 ESRD 患者。患者从开始血液透析到肾移植、死亡或 2016 年 12 月 31 日（以先发生者为准）进行随访。我们计算了癌症的发病率、存活率和风险因素。
在总计 14382 例 ESRD 患者中，有 1124 例（7.82%；男：女，728：396）在随访期间被诊断患有癌症。从开始血液透析到新癌症确诊的平均时间为 64.40±41.81 个月。发生新癌症的显著风险因素为年龄较大、男性和肝病。相反，患有糖尿病的患者发生新癌症的风险较低。男性中最常见的癌症原发部位是结直肠（17.31%），其次是肝脏（15.8%）、胃（14.29%）、肺（13.6%）和肾（10.3%）。在女性中，结直肠（14.65%）也是最常见的癌症原发部位，其次是乳腺（12.88%）、甲状腺（12.63%）、胃（10.86%）和肺（8.08%）。根据癌症原发部位，乳腺癌的中位总生存时间最长（130.93 个月），其次是甲状腺癌、肾癌、结直肠癌、膀胱癌、胃癌、肝癌和肺癌。多变量分析显示，总体生存率受年龄和糖尿病的影响。
慢性血液透析患者的癌症发病率相对较高。因此，需要对慢性血液透析患者进行仔细监测和特定的癌症筛查计划。
