When evaluating clinical outcomes, patients in the HD group had a significantly worse 5-year CSS compared with non-HD: 82.8% vs 93.5% (P =.02). Similarly, HD was also associated with significantly lower overall survival (OS), although the specific percentages were not provided from the Kaplan-Meier analysis and curves.

Multivariate analyses indicated that HD (hazard ratio [HR], 5.11; P =.002), stage (HR, 7.50-125; P <.025) and Fuhrman nuclear grade 4 (HR, 26; P =.002) were independent prognostic factors for RCC CSS. Univariate analysis also found HD to be an independent prognostic factor for CSS, albeit at a lower HR (2.34, P =.024). Outside of death from RCC itself, the most common causes of death in patients on HD included cardiovascular events (myocardial infarctions, strokes, and sudden cardiac death), infections and malignancy other than RCC.

The authors concluded that patients with RCC who are on HD had a worse prognosis compared with those not receiving HD. These findings are in contrast to some prior studies, including a study published by Neuzillet et al that evaluated a total of 1250 patients with RCC (303 HD, 947 non-HD) from 24 university departments in France.7 In this study, the univariate analysis found that ESRD was a favorable prognostic factor, while multivariate analysis did not show any significance.


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Hayami et al explained that their findings may be due to the high 5-year CSS rates in the patients not getting HD, which may be at least partially attributable to higher rates of incidental diagnosis. These high rates of incidental diagnosis can also be a byproduct of the Japan’s national health insurance system. In contrast, the 5-year CSS rates for those patients on HD were lower when compared with prior studies.6,7 The authors attributed this to the long duration of HD with a median time of 168 months along with higher incidence of several of the more aggressive subtypes of RCC (ACD-associated, sarcomatoid component, and Fuhrman grade 3/4). In addition, the authors also believed it was reasonable to attribute worse outcomes in the HD group to the complex underlying pathophysiology, including reduced immunity and excess free radicals. These processes may directly impact the development and worsening of RCC, as well as provide a nidus for pathophysiologic states to arise, especially in the cardiovascular and oncologic realm.

This study was limited by several factors, including its retrospective nature and limited patient population, especially in the HD group. The data were taken only from 1 center in a single country. It will be interesting to evaluate the impact of HD on RCC outcomes in future studies, especially those that incorporate multiple centers from different countries.

References

  1. Butler AM, Olshan AF, Kshirsagar AV, et al. Cancer incidence among US Medicare ESRD patients receiving hemodialysis, 1996-2009. Am J Kidney Dis. 2015;65(5):763–772. doi:10.1053/j.ajkd.2014.12.013
  2. Petrolla AA, Maclennan GT. Renal cell carcinoma associated with end stage renal disease. J Urol. 2006;176(1):345. doi:10.1016/j.juro.2006.04.007
  3. Hayami N, Ubara Y, Okaneya T, et al. Outcome of renal cell carcinoma in patients on dialysis compared to non-dialysis patients. Semin Dial. 2020;33(4):316-321. doi:10.1111/sdi.12888.
  4. Satoh S, Tsuchiya N, Habuchi T, et al. Renal cell and transitional cell carcinoma in a Japanese population undergoing maintenance dialysis. J Urol. 2005;174(5):1749-1753. doi:10.1097/01.ju.0000177489.98031.54
  5. Kojima Y, Takahara S, Miyake O, Nonomura N, Morimoto A, Mori H. Renal cell carcinoma in dialysis patients: a single center experience. Int J Urol. 2006;13(8):1045-1048. doi:10.1111/j.1442-2042.2006.01498.x
  6. Hashimoto Y, Takagi T, Kondo T, et al. Comparison of prognosis between patients with renal cell carcinoma (RCC) on hemodialysis and those with renal cell carcinoma in the general population. Int J Clin Oncol. 2015;20(5):1035-1041. doi:10.1007/s10147-015-0812-9
  7. Neuzillet Y, Tillou X, Mathieu R, et al. Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population. Eur Urol. 2011;60(2):366-373. doi:10.1016/j.eururo.2011.02.035