Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
Adv Chronic Kidney Dis. 2021 Sep;28(5):502-508.e1. doi: 10.1053/j.ackd.2021.09.006.
The incidence of cancer is higher in patients with end-stage kidney disease (ESKD) than among the general population. Despite this, screening for cancer is generally not cost-effective and may worsen quality of life in these patients. This is due to high mortality rates (patients are not living long enough to reap the benefits of screening), the inaccuracy of cancer screening tests, and the increased risks associated with therapy in patients with ESKD. Specific groups of patients with ESKD who have a longer-than-expected life expectancy or higher-than-expected cancer risk may benefit from screening. These groups include patients on peritoneal dialysis, patients on home hemodialysis, Black and Asian-American patients, transplant-eligible patients, and those at higher risk of cancer including patients with acquired cystic kidney disease, those who have been previously exposed to cytotoxic agents or aristolochic acid, and patients with a genetic predisposition to cancer. In this narrative review, we will examine the prevalence of and risk factors for cancer in patients with ESKD and the effectiveness of cancer screening, and discuss specific situations in which cancer screening may be effective.
终末期肾病（ESKD）患者的癌症发病率高于一般人群。尽管如此，癌症筛查通常并不能带来成本效益，反而可能会降低这些患者的生活质量。这是由于高死亡率（患者的生存时间不足以从筛查中获益）、癌症筛查测试的不准确性以及 ESKD 患者治疗相关的风险增加所致。ESKD 患者中存在一些特定的群体，他们的预期寿命比一般人长或癌症风险比一般人高，可能会从筛查中受益。这些群体包括腹膜透析患者、家庭血液透析患者、黑人和亚裔美国患者、有资格接受移植的患者，以及那些具有更高癌症风险的患者，包括患有获得性囊性肾病的患者、曾接触细胞毒性药物或马兜铃酸的患者，以及有癌症遗传易感性的患者。在这篇叙述性综述中，我们将检查 ESKD 患者癌症的流行率和风险因素，以及癌症筛查的有效性，并讨论癌症筛查在某些特定情况下可能有效的情况。
