Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Scand J Urol. 2021 Jun;55(3):209-214. doi: 10.1080/21681805.2021.1900387. Epub 2021 Mar 26.
End-stage renal disease (ESRD) is a known risk factor for the development of renal cell carcinoma (RCC). This case-control study was performed to assess the risk in a nationwide cohort and evaluate tumor characteristics and survival in the ESRD-RCC population.
In this study, 9,299 patients with RCC identified in the National Swedish Kidney Cancer Register from 2005 until 2014 and 93,895 matched controls were linked to the Swedish Renal Registry and the National Patient Register. ESRD was defined as chronic kidney disease stage 5, kidney transplantation or kidney dialysis 0-40 years before the diagnosis of RCC.
A total of 117 patients with ESRD and subsequent RCC were identified and compared with 9,087 patients with RCC. There was a 4.5-times increased risk for RCC among ESRD patients (95% CI = 3.6-5.6; < 0.001) compared to matched controls. Longer time with ESRD increased the risk of RCC (ESRD > 9 years, OR = 10.2, 95% CI = 7.0-14.8). The ESRD-RCC patients were younger ( = 0.002), had smaller tumors ( < 0.001) and had lower tumor stage ( = 0.045). The incidence of papillary and chromophobe RCC was higher and clear cell RCC lower among the ESRD patients ( < 0.001). The 5-year overall survival was 50% in ESRD-RCC patients and 63% in RCC-only patients ( < 0.05).
More than 9 years with ESRD increased the risk of developing RCC 10-times compared to individuals without ESRD and the tumors showed a different histopathological pattern. Despite a less advanced tumor stage at diagnosis, the overall survival in ESRD-RCC patients was lower compared to patients with RCC-only.
终末期肾病（ESRD）是肾细胞癌（RCC）发展的已知危险因素。本病例对照研究旨在评估全国队列中的风险，并评估 ESRD-RCC 人群中的肿瘤特征和生存率。
本研究中，2005 年至 2014 年期间，在全国性瑞典肾细胞癌登记处确定了 9299 例 RCC 患者，并与瑞典肾脏登记处和国家患者登记处进行了 93895 例匹配对照。ESRD 定义为慢性肾脏病 5 期、肾移植或肾透析 0-40 年前诊断为 RCC。
共确定了 117 例 ESRD 后并发 RCC 的患者，并与 9087 例 RCC 患者进行了比较。与匹配对照组相比，ESRD 患者发生 RCC 的风险增加了 4.5 倍（95%CI=3.6-5.6；<0.001）。ESRD 时间延长会增加 RCC 的风险（ESRD>9 年，OR=10.2，95%CI=7.0-14.8）。ESRD-RCC 患者更年轻（=0.002），肿瘤更小（<0.001），肿瘤分期更低（=0.045）。ESRD 患者中乳头状和嫌色细胞 RCC 的发生率更高，透明细胞 RCC 发生率更低（<0.001）。ESRD-RCC 患者的 5 年总生存率为 50%，而仅 RCC 患者为 63%（<0.05）。
与无 ESRD 的个体相比，超过 9 年的 ESRD 使发生 RCC 的风险增加了 10 倍，且肿瘤表现出不同的组织病理学模式。尽管诊断时肿瘤分期较低，但与仅 RCC 患者相比，ESRD-RCC 患者的总体生存率较低。
