Stage at Diagnosis and Prognosis of Colorectal, Stomach, Lung, Liver, Kidney, and Bladder Cancers in Dialysis Patients: A Multicenter Retrospective Study Using Cancer Registry Data and Administrative Data
Stage at Diagnosis and Prognosis of Colorectal, Stomach, Lung, Liver, Kidney, and Bladder Cancers in Dialysis Patients: A Multicenter Retrospective Study Using Cancer Registry Data and Administrative Data
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DOI：
10.1159/000521603
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发表时间：
2022-01-28
期刊：
影响因子：
2.5
通讯作者：
Miyashiro, Isao
中科院分区：
文献类型：
--
作者：
Kida, Nanami;Morishima, Toshitaka;Miyashiro, Isao
背景：癌症是影响透析患者生存的重要合并症。然而，目前尚不清楚患癌症的透析患者是否因较晚的检测和较差的预后而处于不利地位。这项研究比较了透析和非透析患者中几种常见癌症类型的诊断阶段和预后。方法：在这项回顾性队列研究中，癌症登记数据与管理数据相关联，以确定2010至2015年间日本大阪府36家医院的透析和非透析患者是否有任何新的癌症诊断。在这些患者中，我们确定了结直肠癌、胃癌、肺癌、肝癌、肾癌和膀胱癌患者的诊断癌症阶段。根据年龄、性别和癌症分期调整的COX比例风险模型，对每种癌症类型的透析和生存时间(长达3年的随访)之间的关系进行了检验。结果：我们分析了2161名透析患者和158,964名非透析癌症患者。透析患者的结直肠癌、肝癌和肾癌的患病率高于非透析患者。在透析患者中，结直肠癌、胃癌、肺癌、肝癌和肾癌的诊断较早，而膀胱癌的诊断则处于晚期。Cox比例风险模型显示，患有结直肠癌、胃癌、肺癌和膀胱癌的透析患者的死亡率显著高于非透析患者(均P<；0.05)。结论：尽管透析患者较早被发现，但他们在几种常见癌症中的死亡率较高。这种较差的预后可能受到癌症治疗的不可获得性和并发症的影响。
Background: Cancer is an important comorbidity that can affect survival in dialysis patients. However, it is unclear if dialysis patients who develop cancer are disadvantaged by later detection and poorer prognosis. This study comparatively examined the stage at diagnosis and prognosis of several common cancer types in dialysis and nondialysis patients. Methods: In this retrospective cohort study, cancer registry data were linked with administrative data to identify dialysis and nondialysis patients with any new diagnosis of cancer between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. In these patients, we identified the cancer stage at diagnosis for patients with colorectal, stomach, lung, liver, kidney, and bladder cancers. The association between dialysis and survival time (up to 3 years of follow-up) was examined for each cancer type using Cox proportional hazards models that adjusted for age, sex, and cancer stage. Results: We analyzed 2,161 dialysis patients and 158,964 nondialysis patients with cancer. Dialysis patients had a higher prevalence of colorectal, liver, and kidney cancers than nondialysis patients. Colorectal, stomach, lung, liver, and kidney cancers were diagnosed earlier in dialysis patients, whereas bladder cancer was diagnosed at an advanced stage. The Cox proportional hazards models revealed that mortality was significantly higher in dialysis patients with colorectal, stomach, lung, and bladder cancers than in nondialysis patients (all p < 0.05). Conclusions: Dialysis patients had higher mortality for several common cancers despite their earlier detection. This poorer prognosis may be influenced by the unavailability and complications of cancer treatment for these patients.