Ye Junjiang, Ran Biao, Huang Yin, Chen Zeyu, Wu Ruicheng, Li Dengxiong, Wang Puze, Chen Bo, Han Ping, Liu Liangren
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China.
World J Surg Oncol. 2025 Apr 4;23(1):118. doi: 10.1186/s12957-025-03763-9.
Studies have demonstrated an elevated risk of urological malignancies in individuals undergoing dialysis, which consequently leads to unfavorable prognoses and diminished quality of life for patients with end-stage kidney disease. Nevertheless, the absence of standardized recommendations for cancer screening and limited utilization of conventional screening methods within the dialysis population remain prevalent issues.
A meta-analysis was conducted on cohort studies published prior to June 2024, aiming to quantify the cancer risk among individuals undergoing dialysis. Random-effects meta-analyses were employed to combine standardized incidence rates (SIRs) along with their corresponding 95% confidence intervals, considering a p-value of less than 0.05 or an I² value exceeding 50%. Subgroup analyses, heterogeneity tests, and sensitivity analyses were performed as well.
A total of 10 studies, consisting of 12 cohort studies, were ultimately identified, encompassing a collective patient population of 1,362,196 individuals. Compared to the general population, the pooled SIRs for all cancers except non-melanoma skin cancer (NMSC), major urological cancers (MUCs), cancers of the kidney/renal pelvis, bladder cancers and prostate cancers were 1.40 (95% CI: 1.28-1.54), 1.76 (95% CI: 1.45-2.14), 4.73 (95% CI: 3.96-5.64), 1.89 (95% CI: 1.61-2.21) and 0.94 (95% CI: 0.79-1.11), respectively. The cancer risk was notably elevated in specific subgroups of women, younger patients (age at first dialysis, 0-34 years), during the initial year of dialysis, and among Asian patients. SIRs differed when considering different primary renal diseases. However, high heterogeneity was observed among the studies investigating cancers during dialysis, while this heterogeneity did not have a substantial impact on the pooled SIRs for overall cancer, as determined through sensitivity analysis.
Compared with the general population, the dialysis population had a significantly increased risk of developing urological malignancies, particularly cancers of the kidney/renal pelvis. Our findings indicate a substantial increase in risks among female, young, Asian patients, during the first year of dialysis and highlight variations in SIRs based on primary renal disease. These results suggest the potential for adopting a more personalized approach to cancer screening in chronic dialysis patients. Given the considerable heterogeneity observed, further rigorous investigations are warranted to enhance our understanding in this area.
研究表明，接受透析的个体患泌尿系统恶性肿瘤的风险升高，这进而导致终末期肾病患者预后不良和生活质量下降。然而，透析人群中缺乏癌症筛查的标准化建议以及传统筛查方法的使用有限，这些问题仍然普遍存在。
对2024年6月之前发表的队列研究进行荟萃分析，旨在量化接受透析的个体患癌症的风险。采用随机效应荟萃分析来合并标准化发病率（SIRs）及其相应的95%置信区间，显著性水平设定为p值小于0.05或I²值超过50%。同时进行了亚组分析、异质性检验和敏感性分析。
最终确定了总共10项研究，包括12项队列研究，涵盖了总计1,362,196名患者。与普通人群相比，除非黑色素瘤皮肤癌（NMSC）、主要泌尿系统癌症（MUCs）、肾/肾盂癌、膀胱癌和前列腺癌外，所有癌症的合并SIRs分别为1.40（95%CI：1.28 - 1.54）、1.76（95%CI：1.45 - 2.14）、4.73（95%CI：3.96 - 5.64）、1.89（95%CI：1.61 - 2.21）和0.94（95%CI：0.79 - 1.11）。女性、年轻患者（首次透析年龄为0 - 34岁）、透析第一年以及亚洲患者的特定亚组中，癌症风险显著升高。考虑不同的原发性肾脏疾病时，SIRs有所不同。然而，在研究透析期间癌症的研究中观察到高度异质性，而通过敏感性分析确定，这种异质性对总体癌症的合并SIRs没有实质性影响。
与普通人群相比，透析人群患泌尿系统恶性肿瘤的风险显著增加，尤其是肾/肾盂癌。我们的研究结果表明，女性、年轻患者、亚洲患者在透析第一年的风险大幅增加，并突出了基于原发性肾脏疾病的SIRs差异。这些结果表明，在慢性透析患者中采用更个性化的癌症筛查方法具有潜力。鉴于观察到的显著异质性，有必要进行进一步严格的研究，以加深我们对该领域的理解。
