Lu Ming-Shian, Chen Miao-Fen, Yang Yao-Hsu, Lee Chuan-Pin, Lin Chien-Chao, Tseng Yuan-Hsi, Tsai Ying-Huang
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, ChiaYi, Taiwan.
Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan and Chang Gung University, College of Medicine, ChiaYi, Taiwan.
Arch Med Sci. 2019 Jul 22;19(1):86-93. doi: 10.5114/aoms.2019.86783. eCollection 2023.
The survival outcome of lung cancer patients with end-stage renal disease has been poorly studied in the literature. In this study, we evaluated the effect of end-stage renal disease on lung cancer survival.
A retrospective, multicenter, matched-cohort study of lung cancer patients with end-stage renal disease under renal replacement therapy (WITH-ESRD) and without end-stage renal disease (WITHOUT-ESRD) was performed. One WITH-ESRD patient was matched to four WITHOUT-ESRD patients.
Baseline clinical characteristics did not differ statistically significantly after matching between the WITH-ESRD and WITHOUT-ESRD groups. WITH-ESRD included 133 patients and WITHOUT-ESRD included 532 patients. Kaplan-Meier survival analysis demonstrated no significant difference in median overall survival between WITH-ESRD patients and WITHOUT-ESRD patients (7.36 months versus 12.25 months, respectively, = 0.133). Lung cancer WITH-ESRD patients receiving medical treatment had a median overall survival of 5.98 months (95% CI: 4.34-11.76) compared to 14.13 months (95% CI: 11.30-16.43) for WITHOUT-ESRD patients, = 0.019. Although patients receiving surgical treatment compared to those receiving medical treatment had an improvement of survival by 46% (HR = 0.54, 95% CI: 0.19-1.53, = 0.243), the difference did not reach statistical significance. Cox regression analysis revealed that male gender and stage IIIA-IV were independent factors associated with poor outcome for WITH-ESRD patients.
In our limited experience, the survival for lung cancer with ESRD is not inferior to lung cancer patients without ESRD. The reasons for poor survival for the WITH-ESRD medical treatment group and late diagnosis despite frequent medical visits merit further investigation.
肺癌合并终末期肾病患者的生存结局在文献中研究较少。在本研究中，我们评估了终末期肾病对肺癌生存的影响。
对接受肾脏替代治疗的肺癌合并终末期肾病患者（WITH-ESRD）和无终末期肾病患者（WITHOUT-ESRD）进行了一项回顾性、多中心、匹配队列研究。1例WITH-ESRD患者与4例WITHOUT-ESRD患者进行匹配。
匹配后，WITH-ESRD组和WITHOUT-ESRD组的基线临床特征在统计学上无显著差异。WITH-ESRD组包括133例患者，WITHOUT-ESRD组包括532例患者。Kaplan-Meier生存分析显示，WITH-ESRD患者和WITHOUT-ESRD患者的中位总生存期无显著差异（分别为7.36个月和12.25个月，P = 0.133）。接受药物治疗的肺癌WITH-ESRD患者的中位总生存期为5.98个月（95%CI：4.34 - 11.76），而WITHOUT-ESRD患者为14.13个月（95%CI：11.30 - 16.43），P = 0.019。尽管接受手术治疗的患者与接受药物治疗的患者相比，生存期改善了46%（HR = 0.54，95%CI：0.19 - 1.53，P = 0.243），但差异未达到统计学意义。Cox回归分析显示，男性性别和ⅢA - Ⅳ期是WITH-ESRD患者预后不良的独立因素。
根据我们有限的经验，ESRD肺癌患者的生存率并不低于无ESRD的肺癌患者。WITH-ESRD药物治疗组生存率低以及尽管频繁就诊仍诊断较晚的原因值得进一步研究。
