Chronic Kidney Disease Development in Cancer Treatment and Survival

项目摘要/摘要 慢性肾脏病(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预后，但 这种影响的证据是有限的。我们在这项提案中寻求扩大对 CKD作为癌症死亡率的危险因素，并量化CKD事件在 接受特定的潜在肾毒性癌症方案治疗的患者。尤其是顺铂， 卡铂、卡培他滨、伊立替康和依托泊苷是标准癌症的成分。 治疗方案，接受治疗的个人在一些癌症中CKD的风险增加， 但标准肺癌或结直肠癌治疗后的风险尚不清楚。大致 据估计，到2020年，美国15%的成年人会受到慢性肾脏病的影响。有一个 迫切需要了解慢性肾脏病的发病、进展和死亡的风险 癌症治疗的最新进展。我们将利用一个大型的、基于人口的数据集，即监视数据集 国家癌症研究所的流行病学最终结果(SEER)计划，与医疗保险有关 (SEER-Medicare)，以解决CKD和癌症对预后的影响问题。 令人惊讶的是，现有文献中几乎没有涉及长期随访的文献。这样的证据可能是 对减少肾毒性、急性肾损伤并确保剂量限制副作用至关重要 抗肿瘤药物并不妨碍感兴趣的癌症的有效治疗。我们将分析 索赔数据以评估CKD患者患癌症或与CKD相关的风险是否更高 癌症治疗后的死亡率以及特定治疗是否可能增加慢性肾脏病的风险 发病率。这些分析应该会大大提高对慢性肾脏病诊断的认识，并 它在治疗过程中发展，导致额外的监测，个性化治疗，以及 癌症和慢性肾脏病患者的潜在生存益处相同。

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.