Abstract
It is well known that the prognosis is relatively good in patients on dialysis for end-stage renal disease with renal cell carcinoma (RCC). In patients on long-term dialysis, especially those with a history of more than twenty years, however, it is uncertain whether similar results could be obtained. To investigate tumor characteristics in long-term hemodialysis patients, we retrospectively examined the histopathological findings and prognose of 125 hemodialysis patients who underwent radical nephrectomy for RCC at our hospital between 1982 and 2004. Patients were divided into two groups ; (1) patients who received dialysis for 3 to 20 years before surgery (group 1, N=92) and (2) patients who received dialysis for more than 20 years before surgery (group 2, N=33). Acquired renal cystic disease was found in all group 2 patients. The cancer grade was significantly higher in group 2 than in group 1 (group 1 with cancer grade 3 : 5.4% vs group 2 with cancer grade 3 : 21.2%, p=0.01). Furthermore, the clinical tumor stage was also higher in group 2 than in group 1 (group 1 with stage III+IV : 19.6% vs group 2 with stage III+IV : 30.3%). There was no significant difference in overall 5-year patient survival between the two groups (group 1 : 70.4% vs group 2 : 68.2%). In contrast, cancer-specific 5-year patient survival was significantly lower in group 2 than in group 1 (group 1 : 91.9% vs group 2 : 68.2%, p<0.001). On multivariate analysis, long-term hemodialysis (≥20 years), cancer grade (grade 3), and clinical tumor stage (stage III+IV) showed a significant correlation with cancer-specific death (relative risks were 3.34, 5.14, and 16.55, respectively). Our study suggests that long-term hemodialysis (≥20 years) itself has a negative impact on prognosis in patients on dialysis who develop RCC.
