Association between chronic kidney disease and mortality in stage IV cancer
Association between chronic kidney disease and mortality in stage IV cancer
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DOI：
10.1007/s10147-020-01715-9
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发表时间：
2020-06-08
影响因子：
3.3
通讯作者：
Komatsu, Yasuhiro
中科院分区：
文献类型：
--
作者：
Ishii, Taisuke;Fujimaru, Takuya;Komatsu, Yasuhiro
背景：慢性肾脏疾病（CKD）与癌症死亡率相关。然而，没有研究考虑众所周知的癌症预后因素，ECOG性能状态（PS）和癌症治疗，作为混杂因素。我们评估了CKD与IV期癌症患者癌症死亡之间的独立关系。方法在本回顾性观察性研究中，我们纳入了2009年至2014年诊断的IV期癌症患者。我们收集了基线临床和实验室变量，以及癌症特异性变量，并评估CKD的存在。我们的主要结局是全因死亡率。次要结局是癌症特异性死亡率和部位特异性癌症死亡率。结果在961例符合条件的IV期癌症患者（中位年龄69岁，男性51.8%）中，150例患者患有CKD。在随访期间（中位9.8个月），638名患者死亡，其中526名患者死于癌症。在调整预后变量后，包括ECOG PS和癌症治疗，CKD患者的全因死亡率和癌症特异性死亡率显著高于非CKD患者（HR分别为1.41,95% CI 1.13-1.77和HR 1.43, 95% CI 1.12-1.83）。在患有乳腺癌、肾癌和尿路癌的患者中，CKD与死亡风险显著增加相关（HR 7.01, 95% CI 1.47-33.4; HR 3.33, 95% CI 1.42-7.78）。结论IV期癌症诊断时CKD与全因死亡率和癌症特异性死亡率相关。此外，CKD与癌症特异性死亡之间的关联是乳腺癌、肾癌和尿路癌的特异性部位。
Background Chronic kidney disease (CKD) is known to be associated with cancer mortality. However, no study has considered the well-known cancer prognostic factors, ECOG Performance Status (PS) and cancer treatment, as confounding factors. We assessed the independent relationship between CKD and cancer death in stage IV cancer patients. Methods In this retrospective observational study, we included stage IV cancer patients diagnosed from 2009 to 2014 in a single center. We collected baseline clinical and laboratory variables, and cancer-specific variables, and assessed the presence of CKD. Our primary outcome was all-cause mortality. The secondary outcome was cancer-specific mortality and site-specific cancer mortality. Results Among 961 eligible stage IV cancer patients (median age 69 years, 51.8% male), 150 patients had CKD. During follow-up (median 9.8 months), 638 patients died, of whom 526 patients died from cancer. After adjusting for prognostic variables, including ECOG PS and cancer treatment, all-cause mortality and cancer-specific mortality were significantly higher in CKD patients than in non-CKD patients (HR 1.41, 95% CI 1.13-1.77 and HR 1.43, 95% CI 1.12-1.83, respectively). In patients with breast and kidney and urinary tract cancers, CKD was associated with a significantly increased risk of death (HR 7.01, 95% CI 1.47-33.4 and HR 3.33, 95% CI 1.42-7.78, respectively). Conclusions CKD at the time of stage IV cancer diagnosis was associated with all-cause mortality and cancer-specific mortality. Moreover, the association between CKD and cancer-specific death was site specific for breast cancer and kidney and urinary tract cancer.