Kidney Function and Risk of Renal Cell Carcinoma.
Kidney Function and Risk of Renal Cell Carcinoma.
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DOI：
10.1158/1055-9965.epi-23-0558
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发表时间：
2023-11-01
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我们评估了肾功能(通过估计的肾小球滤过率(EGFR)进行评估)和肾细胞癌(RCC)风险之间的时间相关性。我们还评估了EGFR是否可以改善肾癌风险区分度，超越既定的危险因素。我们分析了英国生物银行的队列，包括463,178名参与者，其中1,447人在5,696,963人年的随访中被诊断为肾癌。我们使用灵活的参数生存模型评估了EGFR和肾癌风险之间的时间相关性，并对C-反应蛋白和肾癌风险因素进行了调整。根据肌酐和胱抑素C水平计算EGFR。较低的EGFR是肾功能不佳的一个指标，当在诊断前5年测量时，与较高的肾癌风险相关。诊断前1年测量的每标准差RCC HR为1.26[95%可信区间(95%CI)1.16~1.37]，诊断前5年测量的RCC HR为1.11(95%可信区间1.05~1.17)。与已发表的模型(0.69；95%CI，0.63-0.79)相比，在诊断前1年，将EGFR加入到肾癌风险模型中，风险辨别能力略有改善，AUC为0.73(95%CI，0.67-0.84)。这项研究表明，肾功能标志物与肾癌风险相关，但这些关联的性质与反向因果关系一致。肾功能标记物在肾癌风险辨别方面的改善有限，超出已确定的危险因素。EGFR可用于识别处于风险分布极端的个体。
We evaluated the temporal association between kidney function, assessed by estimated glomerular filtration rate (eGFR), and the risk of incident renal cell carcinoma (RCC). We also evaluated whether eGFR could improve RCC risk discrimination beyond established risk factors. We analyzed the UK Biobank cohort, including 463,178 participants of whom 1,447 were diagnosed with RCC during 5,696,963 person-years of follow-up. We evaluated the temporal association between eGFR and RCC risk using flexible parametric survival models, adjusted for C-reactive protein and RCC risk factors. eGFR was calculated from creatinine and cystatin C levels. Lower eGFR, an indication of poor kidney function, was associated with higher RCC risk when measured up to 5 years prior to diagnosis. The RCC HR per SD decrease in eGFR when measured 1 year before diagnosis was 1.26 [95% confidence interval (95% CI), 1.16–1.37], and 1.11 (95% CI, 1.05–1.17) when measured 5 years before diagnosis. Adding eGFR to the RCC risk model provided a small improvement in risk discrimination 1 year before diagnosis with an AUC of 0.73 (95% CI, 0.67–0.84) compared with the published model (0.69; 95% CI, 0.63–0.79). This study demonstrated that kidney function markers are associated with RCC risk, but the nature of these associations are consistent with reversed causality. Markers of kidney function provided limited improvements in RCC risk discrimination beyond established risk factors. eGFR may be of potential use to identify individuals in the extremes of the risk distribution.