Ishii Taisuke, Watanabe Tomone, Ichinose Yuichi, Mano Hiroyuki, Higashi Takahiro
Division of Health Services Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan.
Cancer Med. 2025 Sep;14(17):e71237. doi: 10.1002/cam4.71237.
Patients with chronic kidney disease (CKD) face unique challenges in cancer treatment, including the need for chemotherapy dose adjustments and avoiding nephrotoxic agents, often leading to less aggressive treatment. However, little is known about the real-world administration of adjuvant chemotherapy for patients with CKD. In this study, we aimed to investigate the prevalence of adjuvant chemotherapy in patients with CKD and to explore factors influencing chemotherapy use.
We retrospectively analyzed data from the Diagnosis Procedure Combination survey and hospital-based cancer registry in Japan. Adult patients diagnosed with colon, gastric, breast, or non-small-cell lung cancer who underwent curative surgery from January 2016 to December 2019 were included. CKD was identified based on International Classification of Diseases, 10th revision codes, and CKD-related medication prescriptions. The primary outcome was the proportion of patients receiving adjuvant chemotherapy, and secondary outcomes were regimen details.
A total of 109,875 patients were included in the study, 4.5% (4953) of whom had CKD. Patients with CKD were older and had a higher prevalence of comorbidities. A smaller proportion of patients with CKD received adjuvant chemotherapy (41.7% vs. 64.5%, p < 0.001). CKD was independently associated with lower odds of receiving adjuvant chemotherapy (odds ratio: 0.51, 95% confidence interval: 0.48-0.55). Patients with CKD were also less likely to receive standard chemotherapy regimens or those requiring dose adjustments.
Patients with CKD received adjuvant chemotherapy less frequently, likely owing to concerns about kidney toxicity and dose adjustments. Individualized treatment approaches are needed to optimize outcomes for this population.
慢性肾脏病（CKD）患者在癌症治疗中面临独特挑战，包括需要调整化疗剂量以及避免使用肾毒性药物，这往往导致治疗不够积极。然而，对于CKD患者辅助化疗的实际应用情况知之甚少。在本研究中，我们旨在调查CKD患者辅助化疗的患病率，并探讨影响化疗使用的因素。
我们回顾性分析了日本诊断程序组合调查和基于医院的癌症登记处的数据。纳入了2016年1月至2019年12月期间接受根治性手术的成年结肠癌、胃癌、乳腺癌或非小细胞肺癌患者。根据国际疾病分类第10版编码和与CKD相关的药物处方来确定CKD。主要结局是接受辅助化疗的患者比例，次要结局是治疗方案细节。
本研究共纳入109,875例患者，其中4.5%（4953例）患有CKD。CKD患者年龄较大，合并症患病率较高。接受辅助化疗的CKD患者比例较小（41.7%对64.5%，p<0.001）。CKD与接受辅助化疗的较低几率独立相关（比值比：0.51，95%置信区间：0.48 - 0.55）。CKD患者也不太可能接受标准化疗方案或需要调整剂量的方案。
CKD患者接受辅助化疗的频率较低，可能是由于担心肾毒性和剂量调整。需要采用个体化治疗方法来优化该人群的治疗结局。
