Increased risk for renal cell carcinoma in end stage renal disease – a population-based case-control study

Erik Holmberg,Sven Lundstam,Per Lindblad,Maria Stendahl,Börje Ljungberg,Andreas Thorstenson,John Åkerlund

doi:10.1080/21681805.2021.1900387

Abstract

Purpose End-stage renal disease (ESRD) is a known risk factor for the development of renal cell carcinoma (RCC). This case-control study was performed to assess the risk in a nationwide cohort and evaluate tumor characteristics and survival in the ESRD-RCC population. Methods In this study, 9,299 patients with RCC identified in the National Swedish Kidney Cancer Register from 2005 until 2014 and 93,895 matched controls were linked to the Swedish Renal Registry and the National Patient Register. ESRD was defined as chronic kidney disease stage 5, kidney transplantation or kidney dialysis 0–40 years before the diagnosis of RCC. Results A total of 117 patients with ESRD and subsequent RCC were identified and compared with 9,087 patients with RCC. There was a 4.5-times increased risk for RCC among ESRD patients (95% CI = 3.6–5.6; p < 0.001) compared to matched controls. Longer time with ESRD increased the risk of RCC (ESRD > 9 years, OR = 10.2, 95% CI = 7.0–14.8). The ESRD-RCC patients were younger (p = 0.002), had smaller tumors (p < 0.001) and had lower tumor stage (p = 0.045). The incidence of papillary and chromophobe RCC was higher and clear cell RCC lower among the ESRD patients (p < 0.001). The 5-year overall survival was 50% in ESRD-RCC patients and 63% in RCC-only patients (p < 0.05). Conclusion More than 9 years with ESRD increased the risk of developing RCC 10-times compared to individuals without ESRD and the tumors showed a different histopathological pattern. Despite a less advanced tumor stage at diagnosis, the overall survival in ESRD-RCC patients was lower compared to patients with RCC-only.

Highlights

End-stage renal disease (ESRD) is a global health burden, with 564,638 affected individuals in Europe in 2016, equivalent to an overall prevalence of 823 patients per million population [1]
Of the 117 ESRD and subsequent RCC diagnosis (ESRDRCC) patients, 69 (59%) were transplanted before the renal cell carcinoma (RCC) diagnosis compared to 98 patients (37%) among 264 ESRD controls (p < 0.001)
In the group of patients with ESRD-RCC we found significantly more papillary and chromophobe RCCs

Summary

Introduction

End-stage renal disease (ESRD) is a global health burden, with 564,638 affected individuals in Europe in 2016, equivalent to an overall prevalence of 823 patients per million population [1]. 20% of patients with chronic kidney disease (CKD) who are treated with dialysis end up having acquired cystic kidney disease (ACKD) [11,12] These patients have an increased risk of developing RCC and in clinical settings it has been described that 5% who undergo transplantation after dialysis develop RCC in their native kidneys [8,13,14,15]. It may be useful to estimate the risk of developing RCC after various times with ESRD in a real-world setting in order to design screening programs for this patient group. The Swedish healthcare registers are of high quality and have high coverage [18] This case control study was designed based on these registers, including the whole Swedish population, with the aim to evaluate the risk of Department of Urology, Sahlgrenska University Hospital, Bruna stråket 11, Gothenburg, 405 ß 2021 The Author(s).

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Discussion

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