Calderon-Margalit Ronit, Efron Gil, Pleniceanu Oren, Tzur Dorit, Stern-Zimmer Michal, Afek Arnon, Erlich Tomer, Derazne Estela, Kark Jeremy D, Keinan-Boker Lital, Twig Gilad, Vivante Asaf
Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel.
Department of Military Medicine, Hebrew University of Jerusalem, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.
Kidney Int Rep. 2021 Jan 10;6(4):946-952. doi: 10.1016/j.ekir.2021.01.003. eCollection 2021 Apr.
Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common kidney diseases in childhood. Alterations in genes governing nephrogenesis may cause CAKUT, and in some cases may contribute to development of urinary tract (UT) tumors later in life. We aimed to assess the association between CAKUT and UT cancer in adulthood.
We conducted a population-based historical cohort study encompassing 1,510,042 recruits to the Israeli army between 1967 and 1997. CAKUT exposure was determined by army medical coding of CAKUT in childhood. Incidence of UT cancer (kidney, ureter, or bladder) was available through record linkage with the Israeli Cancer Registry. Recruits were followed from the prerecruitment assessment until cancer diagnosis, death, or study termination, in 2012. Cox proportional hazards models were constructed to estimate the hazard ratios (HRs) for UT cancer in participants with vs. without CAKUT.
During a mean follow-up of 30.4 years, 2959 participants (2573 men and 386 women) developed UT cancer. Men with CAKUT exhibited an increased risk of UT cancer compared with men without CAKUT, yielding an adjusted HR of 1.98 (95% confidence interval [CI] 1.03-3.82). Among women CAKUT was associated with a HR of 5.88 (95% CI 2.19-15.76). Notably, upon stratification according to age of cancer diagnosis, the association between CAKUT and UT cancer was statistically significant only before 45 years of age in women and only after 45 years of age in men.
CAKUT is associated with a significantly increased risk of UT cancer, although the incidence and absolute risk remained quite low.
先天性肾和尿路畸形（CAKUT）是儿童时期最常见的肾脏疾病。调控肾发生的基因改变可能导致CAKUT，在某些情况下可能会促使日后发生尿路（UT）肿瘤。我们旨在评估CAKUT与成年期UT癌症之间的关联。
我们进行了一项基于人群的历史性队列研究，纳入了1967年至1997年间应征加入以色列军队的1,510,042名新兵。儿童时期的CAKUT暴露情况通过军队医疗记录中CAKUT的编码来确定。UT癌症（肾脏、输尿管或膀胱）的发病率可通过与以色列癌症登记处的记录链接获得。从入伍前评估开始对新兵进行随访，直至2012年癌症诊断、死亡或研究终止。构建Cox比例风险模型以估计有CAKUT与无CAKUT参与者发生UT癌症的风险比（HR）。
在平均30.4年的随访期间，2959名参与者（2573名男性和386名女性）发生了UT癌症。与无CAKUT的男性相比，有CAKUT的男性发生UT癌症的风险增加，校正后的HR为1.98（95%置信区间[CI] 1.03 - 3.82）。在女性中，CAKUT与HR为5.88（95% CI 2.19 - 15.76）相关。值得注意的是，根据癌症诊断年龄分层后，CAKUT与UT癌症之间的关联仅在女性45岁之前以及男性45岁之后具有统计学意义。
CAKUT与UT癌症风险显著增加相关，尽管发病率和绝对风险仍然相当低。
