Chronic Kidney Disease Development in Cancer Treatment and Survival

项目概要/摘要 慢性肾病（CKD），定义为3-5期，包括终末期肾病 （ESRD））在癌症诊断时被认为会影响癌症的结果，但基础 这种影响的证据有限。我们在本提案中寻求扩大对以下问题的理解： CKD作为癌症死亡率的危险因素，并量化 接受特定潜在肾毒性癌症治疗方案治疗的患者。特别是顺铂， 卡铂、卡培他滨、伊立替康和依托泊苷是标准癌症的组分， 治疗方案和治疗个体在某些癌症中具有增加的CKD风险， 但标准肺癌或结肠直肠癌治疗后的风险尚不清楚。约 据估计，截至2020年，美国有15%的成年人患有CKD。有一个 迫切需要了解CKD发病率、进展和死亡率的风险 癌症治疗的方法。我们将利用一个大型的，基于人口的数据集，即监测 国家癌症研究所的流行病学最终结果（SEER）计划，与医疗保险相关联 （SEER-Medicare），以解决CKD和癌症预后的重要问题。 令人惊讶的是，现有文献很少涉及长期随访。这些证据可能是 关键是减少肾毒性，急性肾损伤，并确保剂量限制的副作用， 抗肿瘤剂不妨碍目标癌症的有效治疗。我们将分析 声称数据评估CKD患者是否有更大的癌症风险或CKD相关风险 癌症治疗后的死亡率，以及特定治疗是否会增加CKD的风险 发病率。这些分析应大大提高诊断时对CKD的认识， 在治疗过程中发展，导致额外的监测，个性化治疗， 对癌症和CKD患者的潜在生存益处。

Project Summary/Abstract Chronic kidney disease (CKD), defined as Stages 3-5, including end stage renal disease (ESRD)) at the time of cancer diagnosis is believed to influence cancer outcomes, but the base of evidence for such effects is limited. We seek in this proposal to extend the understanding of CKD as a risk factor for cancer mortality, and to quantify the development of incident CKD in patients treated with specific potentially nephrotoxic cancer regimens. In particular, cisplatin, carboplatin, capecitabine, irinotecan, and etoposide are components of standard cancer treatment protocols, and treated individuals have had an increased CKD risk in some cancers, but the risk following standard lung or colorectal cancer treatment is unknown. Approximately 15% of adults in the United States are estimated to be affected with CKD as of 2020. There is a pressing need to understand the risks of CKD incidence, progression and mortality in the setting of cancer treatment. We will utilize a large, population-based dataset, that of the Surveillance Epidemiology End Results (SEER) program of the National Cancer Institute, linked to Medicare (SEER-Medicare), to address question of import to prognosis in both CKD and cancer. Surprisingly little of the existing literature concerns long-term follow-up. Such evidence could be crucial to reduce nephrotoxicity, acute kidney injury, and ensure that dose-limiting side effects of antineoplastic agents do not prevent effective therapy of the cancer of interest. We will analyze claims data to evaluate whether those with CKD are at greater risk of cancer or CKD-related mortality after cancer treatment, and whether particular therapies might increase the risk of CKD incidence. These analyses should greatly heighten awareness of CKD at diagnosis and that which develops during therapy, leading to additional monitoring, personalized therapy, and potential survival benefits for patients with cancer and CKD alike.