Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Abstract

Abstract. It has been reported that patients receiving renal replacement therapy (RRT), including dialysis and kidney transplantation, tend to have an increased risk of cancer; however, studies on the degree of this risk have remained inconclusive. The present meta-analysis was therefore performed to quantify the cancer risk in patients with RRT. Cohort studies assessing overall cancer risk in RRT patients published before May 29, 2015 were included following systematic searches with of PubMed, EMBASE and the reference lists of the studies retrieved. Random-effects meta-analyses were used to pool standardized incidence rates (SIRs) with 95% confidence intervals (CIs). Heterogeneity tests, sensitivity analyses and publication bias assessment were performed. A total of 18 studies including 22 cohort studies were eventually identified, which comprised a total of 1,528,719 patients. In comparison with the general population, the pooled SIR for patients with dialysis including non-melanoma skin cancer (NMSC), dialysis excluding NMSC, transplantation including NMSC, transplantation excluding NMSC and RRT were 1.40 (95% CI, 1.36-1.45), 1.35 (95% CI, 1.23-1.50), 3.26 (95% CI, 2.29-4.63), 2.08 (95% CI, 1.73-2.50) and 2.01 (95% CI, 1.70-2.38), respectively. The cancer risk was particularly high in subgroups of large sample size trials, female patients, younger patients (age at first dialysis, 0-34 years; age at transplantation, 0-20 years), the first year of RRT and non-Asian transplant patients. A significant association was also found between RRT and the majority of organ-specific cancers. However, neither dialysis nor transplantation was associated with breast, body of uterus, colorectal or prostate cancer. Significant heterogeneity was found regarding the association between RRT and overall cancer as well as the majority of site-specific cancer types. However, this heterogeneity had no substantial influence on the pooled SIR for overall cancer in RRT according to the sensitivity analysis. Compared with the general population, RRT patients have a significantly increased risk of overall cancer and the majority of specific cancer types, particularly Kaposi sarcoma (KS), lip cancer and NMSC in patients subjected to kidney transplantation and cancer of the thyroid gland and kidney as well as myeloma in dialysis patients. Considering the high heterogeneity encountered, further high-quality studies are required.

Prostate cancer in kidney transplant recipients – a nationwide register study

“…Our present results, based on 133 prostate cancer cases, agree well with the by far largest study of cancer incidence amongst solid transplant recipients (1039 prostate cancer cases) , with a meta‐analysis of six studies published before 2015 , and with a recent study from Australia and New Zealand (41 prostate cancer cases) . At odds with these and with our present study are two smaller studies: one Irish (34 prostate cancer cases) and one Swiss (18 prostate cancer cases), which reported a seven‐fold and a four‐fold higher prostate cancer incidence in kidney transplant recipients compared with the male population .…”

Urologic malignancies in kidney transplantation

“…To assess the cancer risk of patients receiving renal replacement therapy, Shang et al performed a meta‐analysis of multiple cohort studies and found a pooled SIR for RCC of 9.7 (95% CI 5.69‐16.53) among transplant recipients compared with a pooled SIR of 4.87 (95% CI 4.14‐5.72) among dialysis patients, suggesting that the risk of RCC is higher among transplant patients than among dialysis patients . In contrast to the findings of Shang et al, a recent retrospective analysis of the national transplant registry by Yanik and colleagues demonstrated that the SIR for RCC was lower among first‐time transplant recipients (SIR 6.4, 95%CI 5.9‐6.8) compared with waitlist candidates (SIR 9, 95% CI 8.4‐9.6).…”

“…Compared with the general population, transplant recipients had similar stage‐stratified, disease‐specific survival for stage I/II RCCs but significantly worse survival for stage IV RCC (0% difference versus 20% difference at 3 years), and transplantation itself was a significant risk factor for disease‐related mortality . A meta‐analysis of cancer risk after transplantation found it to be highest in the first year after surgery with a subsequent decrease over time . Reasons for this high initial risk are likely multifactorial.…”

Clinical applications of uterus transplantation in China: Issues to take into consideration

“…However, transplant recipients of solid organs have been documented to be at a higher risk of developing diabetes mellitus and malignancies, especially for female patients . But it is interesting that stratification based on geographical region indicated that the pooled standardized incidence rates of cancers in Asian populations of renal transplant recipients (RTR) were lower than those in non‐Asian RTR . What is more, unlike the kidney, liver and other solid organs, the transplanted uterus can be removed after 1–2 live deliveries.…”

“…[43][44][45][46] But it is interesting that stratification based on geographical region indicated that the pooled standardized incidence rates of cancers in Asian populations of renal transplant recipients (RTR) were lower than those in non-Asian RTR. 47 What is more, unlike the kidney, liver and other solid organs, the transplanted uterus can be removed after 1-2 live deliveries. Thus, the transplant is temporary, limiting the length of immunosuppressive therapy and its side effect on the mothers.…”