Patients with renal cell carcinoma (RCC) have a higher risk of dying from the cancer if they are on hemodialysis (HD), according to a new study.

Among 388 patients who underwent partial or radical nephrectomy for RCC at a Japanese hospital from 2005 to 2013, the 66 patients on HD had a significant 5.1-fold increased risk for cancer-specific mortality compared with the 322 patients not on dialysis, after adjusting for tumor stage and size, Fuhrman nuclear grade, and other factors, Noriko Hayami, MD, of Toranomon Hospital in Kanagawa, Japan, and colleagues reported in Seminars in Dialysis. The investigators said their report is the first to document HD as being an independent prognostic factor for cancer-specific survival among patients with RCC.

The 5-year cancer-specific survival rate was 82.8% among the HD patients compared with 93.5% for the patients not on dialysis.

The study also found that the incidental diagnosis of RCC was less frequent in the HD group than in the patients not on dialysis (65% vs 78%). Compared with the nondialysis group, the HD group had a higher proportion of patients with multicentric tumors (41% vs 1.2%), bilateral disease (14% vs 0.6%), and papillary histology (18 vs 7%). In addition, tumors in the HD group were smaller and of lower stage compared with tumors in the nondialysis group. The HD group had a higher proportion of patients with Fuhrman nuclear grade 3 (13% vs 4%) and 4 (18% vs 8%) disease.


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In addition, the study found that tumor stage and Fuhrman nuclear grade independently predicted cancer-specific survival. On multivariate analysis, tumor stages II, III, and IV were significantly associated with 7.5-, 38.2-, and 125-fold increased risk for RCC mortality, respectively, compared with stage I. Compared with Fuhrman nuclear grade 1, grade 4 was significantly associated with a 26-fold increased risk for RCC mortality.

Patients in both the HD and nondialysis groups had a median age of 61 years. The median follow-up period was shorter for the HD group (42.5 vs 54.5 months).

The incidence of RCC is high among patients with end-stage kidney disease, Dr Hayami’s team noted. Factors possibly associated with this higher incidence include depressed immunity, oxidative stress, impairment of DNA repair, and excessive production of free radicals related to inflammation.

In addition to its retrospective nature, the study was limited by the small number of HD patients, a consequence of having been conducted at a single center, according to the investigators.

Reference

Hayami N, Ubara Y, Okaneya T, et al. Outcome of renal cell carcinoma in patients on dialysis compared to non-dialysis patients. Semin Dial. 2020;33:316-321. doi: 10.1111/sdi.12888