Abstract
Questionnaires were sent to 2, 622 dialysis units in February 1996, to determine the current prevalence of renal cell carcinoma in chronic hemodialysis patients. The response rate was 59.5%. Renal cell carcinomas were detected in 277 dialysis patients between March 1994 and February 1996. The mean age of these 277 patients (222 males and 5 females) was 54.1±11.7 (mean±SD) years, and the mean duration of dialysis was 125.8±79.5 months. Clinical diagnosis was based on sonograhic examination (140 case) and CT scan (112 cases). Only 10 of those patients were symptomatic. Acquired renal cystic disease was found in 222 of 271 renal cell carcinoma patients (81.9%). In 242 cases, renal cell carcinoma was histologically confirmed. Cell typing of 218 renal cell carcinomas revealed that 123 were the clear cell subtype, 44 granular cell subtype and 51 mixed cell subtype. Structural typing of 205 renal cell carcinomas showed that 67 were alveolar, 29 tubular, 49 papillary, 20 cystic, 14 solid and 26 mixed. Granular or mixed cell subtype and tubular or papillary structure were prevalent among patients with more than 5 years of hemodialysis. Forty-five of 273 patients demonstrated metastasis. Two hundred seventy-seven renal cell carcinomas were detected during the two years preceding this survey and the prevalence was the highest incidence documented in the seven most recent questionnaires. The incidence of renal cell carcinoma in dialysis patients was 12 to 15 times higher than that in the general population. The incidence of renal cell carcinoma in dialysis patients was 163 renal cell carcinomas per 100, 000 dialysis patients per year. In conclusion, renal cell carcinoma accompanied by acquired renal cystic disease in long-term hemodialysis tends to develop in a granular or mixed cell subtype and tubular or papillary structural pattern.
