Division of Nephrology, University of Virginia Health System, Charlottesville, VA.
Am J Kidney Dis. 2020 Oct;76(4):558-566. doi: 10.1053/j.ajkd.2019.12.018. Epub 2020 Apr 15.
Cancer screening guidelines were developed for the general population with the aim of improving health outcomes through early detection. However, these screening recommendations are not generalizable to patients undergoing maintenance dialysis given that their life expectancy is often less than 5 years. In addition, the performance characteristics of screening tests in patients treated by dialysis may not be the same as in the general population, leading to differences in these tests' sensitivity and specificity in detecting cancer. Survival benefits in patients receiving dialysis may also be tempered by increased risks of curative therapies. Given the uncertainties of cancer screening in patients treated by maintenance dialysis, an individualized approach to cancer screening is warranted. This approach should balance the patient's life expectancy and the potential benefits from screening with its potential costs and harm. The special circumstance of renal cell carcinoma in patients treated by dialysis is also discussed.
癌症筛查指南是为一般人群制定的，旨在通过早期发现来改善健康结果。然而，这些筛查建议不适用于接受维持性透析的患者，因为他们的预期寿命通常不到 5 年。此外，透析治疗患者的筛查试验的性能特征可能与一般人群不同，导致这些试验在检测癌症方面的敏感性和特异性有所不同。接受透析治疗的患者的生存获益也可能因根治性治疗的风险增加而受到影响。鉴于维持性透析患者的癌症筛查存在不确定性，有必要采用个体化的癌症筛查方法。这种方法应该平衡患者的预期寿命和筛查的潜在收益与其潜在的成本和危害。还讨论了透析治疗患者肾细胞癌的特殊情况。
