Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 20;18(2):sfae430.
doi: 10.1093/ckj/sfae430. eCollection 2025 Feb.

Cancer diagnosis and prognosis after initiation of hemodialysis: multicenter Japan CANcer and DialYsis (J-CANDY) study

Naoya Toriu  1   2 , Shinya Yamamoto  1 , Takeshi Matsubara  1 , Yuki Kataoka  3   4   5   6 , Kaoru Sakai  1 , Taro Funakoshi  7 , Takahiro Horimatsu  7 , Tatsuo Tsukamoto  8 , Naoka Murakami  9   10 , Kenar D Jhaveri  11 , Shingo Fukuma  12 , Tomohiro Terada  13 , Manabu Muto  7 , Shunichi Fukuhara  4   12 , Motoko Yanagita  1   2 ; Onconephrology Consortium in Japan
Collaborators, Affiliations

Cancer diagnosis and prognosis after initiation of hemodialysis: multicenter Japan CANcer and DialYsis (J-CANDY) study

Naoya Toriu et al. Clin Kidney J. .

Abstract

Background: Cancer is a leading cause of death among patients on hemodialysis; however, the data on its diagnosis, treatment and prognosis are limited. Here we analyzed the surgical practice patterns and outcomes of patients on hemodialysis with cancer and compared them with those of general cancer patients from the National Cancer Center database.

Methods: This nationwide registry enrolled hemodialysis patients who were subsequently diagnosed with primary cancers of the kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast in 20 hospitals in Japan between 2010 and 2012. The primary endpoint was the overall 3-year survival rate. We also examined the association of factors with mortality using Cox regression analysis.

Results: Of the 502 patients, 370 (74%) underwent surgery. More than half of the patients (57%) were asymptomatic at diagnosis and diagnosed with cancer through screening. Among the patients who underwent surgery, most (99%) had resectable cancers; while among those who did not undergo surgery, more than half (52%) had metastatic cancers. The 3-year overall survival in the surgery and non-surgery groups was 83% and 32%, respectively. Non-cancer-related deaths were dominant (80%) in the surgery group, whereas cancer-related deaths were dominant in the non-surgery group (70%). Pancreatic cancer and anemia were associated with a poor prognosis in the surgery group. Surgery and 3-year overall survival rates were comparable between the patients on hemodialysis and the general cancer patients.

Conclusion: Prognosis in hemodialysis cancer patients might be equivalent to that of general cancer patients.

Keywords: cancer; hemodialysis; prognosis; surgery.

PubMed Disclaimer

Conflict of interest statement

M.Y. receives research grants from Mitsubishi Tanabe Pharma and Boehringer Ingelheim. All other authors declare no competing interests.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flow diagram of subject selection process. Among the 674 initially enrolled hemodialysis patients subsequently diagnosed with cancer, 502 patients were analyzed and divided into two groups according to implementation of surgery. HD: hemodialysis.
Figure 2:
Figure 2:
Proportion of selected therapies among patients in the non-surgery group. Among patients in the non-surgery group, the proportion of selected therapies in (A) all patients, (B) patients with resectable disease and (C) patients with locally advanced or metastatic disease. RFA: radiofrequency ablation.
Figure 3:
Figure 3:
Initial cancer condition of patient. Initial cancer condition by cancer type in (A) all patients, (B) patients with surgery and (C) patients without surgery were presented. Because the number of patients with bladder cancer and breast cancer in the non-surgery group was small, initial cancer condition was not evaluated. NE: not evaluated.
Figure 4:
Figure 4:
Comparison of surgery rate between hemodialysis patients and general patients in Japan. Surgery rates were comparable between hemodialysis patients and the general patients (NCC database) in Japan.
Figure 5:
Figure 5:
Comparison of the 3-year survival rates between hemodialysis patients and the general patients in Japan. Three-year survival rates were compared between hemodialysis patients (J-CANDY) and general patients (NCC database) in (A) all patients, (B) patients with surgery and (C) patients without surgery. Because the number of patients with bladder cancer in the non-surgery group was small (n = 2), the 3-year survival rate was not evaluated. NE: not evaluated; ND: no data.
See this image and copyright information in PMC

References

    1. Maisonneuve P, Agodoa L, Gellert R et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999;354:93–9. 10.1016/S0140-6736(99)06154-1 - DOI - PubMed
    1. Iseki K, Osawa A, Fukiyama K. Evidence for increased cancer deaths in chronic dialysis patients. Am J Kidney Dis 1993;22:308–13. 10.1016/S0272-6386(12)70323-2 - DOI - PubMed
    1. Vogelzang JL, van Stralen KJ, Noordzij M et al. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant 2015;30:1028–37. 10.1093/ndt/gfv007 - DOI - PubMed
    1. Masakane I, Taniguchi M, Nakai S et al. Annual Dialysis Data Report 2015, JSDT Renal Data Registry. Ren Replace Ther 2018;4:19. 10.1186/s41100-018-0149-8 - DOI
    1. Janus N, Launay-Vacher V, Thyss A et al. Management of anticancer treatment in patients under chronic dialysis: results of the multicentric CANDY (CANcer and DialYsis) study. Ann Oncol 2013;24:501–7. 10.1093/annonc/mds344 - DOI - PubMed