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Comparative Study
. 2021 Jun;25(6):674-682.
doi: 10.1007/s10157-021-02038-3. Epub 2021 Feb 27.

Outcome of advanced renal cell carcinoma arising in end-stage renal disease: comparison with sporadic renal cell carcinoma

Hiroki Ishihara  1 , Hironori Fukuda  2 , Hidekazu Tachibana  3 , Kazuhiko Yoshida  2 , Hirohito Kobayashi  3 , Toshio Takagi  2 , Junpei Iizuka  2 , Hideki Ishida  2 , Yoji Nagashima  4 , Tsunenori Kondo  3 , Kazunari Tanabe  2
Affiliations
Comparative Study

Outcome of advanced renal cell carcinoma arising in end-stage renal disease: comparison with sporadic renal cell carcinoma

Hiroki Ishihara et al. Clin Exp Nephrol. 2021 Jun.

Abstract

Background: The data regarding oncological outcome in advanced renal cell carcinoma (RCC) arising in end-stage renal disease (ESRD) are limited.

Methods: Patients diagnosed with advanced RCC on maintenance dialysis therapy (ESRD-RCC) and treated with tyrosine kinase inhibitors (TKIs) were retrospectively evaluated. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) after initiation of first-line TKI therapy in ESRD-RCC patients were compared to those in RCC arising in the general population (sporadic RCC).

Results: A total of 36 and 240 patients were diagnosed with advanced ESRD-RCC and sporadic RCC, respectively. PFS and OS were significantly shorter in patients with ESRD-RCC than in those with sporadic RCC (p = 0.0004 and p = 0.0045). After adjusting for histopathological type, MSKCC risk and liver metastasis status, ESRD status (ESRD-RCC vs. sporadic RCC) was not an independent risk factor for PFS or OS (both, p > 0.05). The ORR tended to be lower in patients with ESRD-RCC than in those with sporadic RCC (11% vs. 28%, p = 0.0833). In 34 patients with ESRD-RCC treated with sorafenib, longer duration of dialysis was an independent prognostic factor for shorter OS (hazard ratio 3.21, p = 0.0370).

Conclusions: Outcome of advanced ESRD-RCC was poorer than that of sporadic RCC, but this finding was affected by other prognostic factors. Nevertheless, the study suggested that advanced ESRD-RCC was not an indolent disease. Additionally, patients with a longer duration of dialysis therapy might require careful monitoring.

Keywords: Chronic kidney disease; Hemodialysis; Kidney cancer; Metastatic renal cell carcinoma; Prognosis.

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