De novo cancer in patients on dialysis and after renal transplantation: north-western Italy, 1997–2012

Mazzucotelli, Valentina; Piselli, Pierluca; Verdirosi, Diana; Cimaglia, Claudia; Cancarini, Giovanni; Serraino, Diego

doi:10.1007/s40620-017-0385-y

Cited by 25 publications

(21 citation statements)

References 16 publications

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“…The increased risk of cancer in dialysis patients has been well documented in Asia [3, 6], United States [7], Australia/New Zealand [2], and northern Europe [9]. Conversely, less evidence has been accumulated in southern European countries, such as Italy, where end-stage kidney disease (ESKD) patients represent about 0.1% of the general population [10], and only a small study has been published in the international literature [11].…”

Section: Introductionmentioning

confidence: 99%

Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy

et al. 2019

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Background In southern Europe, the risk of cancer in patients with end-stage kidney disease receiving dialysis has not been well quantified. The aim of this study was to assess the overall pattern of risk for de novo malignancies (DNMs) among dialysis patients in the Friuli Venezia Giulia region, north-eastern Italy. Methods A population-based cohort study among 3407 dialysis patients was conducted through a record linkage between local healthcare databases and the cancer registry (1998–2013). Person-years (PYs) were calculated from 30 days after the date of first dialysis to the date of DNM diagnosis, kidney transplant, death, last follow-up or December 31, 2013, whichever came first. The risk of DNM, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). Results During 10,798 PYs, 357 DNMs were diagnosed in 330 dialysis patients. A higher than expected risk of 1.3-fold was found for all DNMs combined (95% CI: 1.15–1.43). The risk was particularly high in younger dialysis patients (SIR = 1.88, 95% CI: 1.42–2.45 for age 40–59 years), and it decreased with age. Moreover, significantly increased DNM risks emerged during the first 3 years since dialysis initiation, especially within the first year (SIR = 8.52, 95% CI: 6.89–10.41). Elevated excess risks were observed for kidney (SIR = 3.18; 95% CI: 2.06–4.69), skin non-melanoma (SIR = 1.81, 95% CI: 1.46–2.22), oral cavity (SIR = 2.42, 95% CI: 1.36–4.00), and Kaposi’s sarcoma (SIR = 10.29, 95% CI: 1.25–37.16). Conclusions The elevated risk for DNM herein documented suggest the need to implement a targeted approach to cancer prevention and control in dialysis patients.

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Section: Introductionmentioning

confidence: 99%

Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy

et al. 2019

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“…When analysing the 21 stcentury literature in relation to the incidence of tumour recurrence after LT, the lack of attention paid to the impact of IS on the outcome of liver cancer recipients is surprising. The link between IS and oncogenesis has been unequivocally proven both in laboratory and clinical settings (24)(25)(26)(27)(28)(29)(30). The increase in cancer risk has already been ascertained in patients receiving IS as well as in patients with an end-stage organ failure.…”

Section: Immunosuppression (Is) and Carcinogenesismentioning

confidence: 99%

“…Nevertheless, only virus-related cancers have a higher incidence after post-transplant IS. Oncogenic viruses can immortalise infected cells by disrupting the cell-cycle control and, in a setting of induced lowered immune surveillance, this phenomenon is likely to cause tumorigenesis (29,30). Basic research is important for further progress in transplantation oncology as demonstrated by the following two examples.…”

Section: Immunosuppression (Is) and Carcinogenesismentioning

confidence: 99%

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

Lerut

Iesari

Foguenne

et al. 2017

Transl. Gastroenterol. Hepatol.

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Liver transplantation (LT) has originally been designed to treat hepatobiliary malignancies. The initial results of LT for hepatocellular cancer (HCC) were, however, dismal this mainly due to the poor patient selection procedure. Better surgical and perioperative care and, especially, the refinement of selection criteria led to a major improvement of results, making HCC nowadays (again!) one of the leading indications for LT. This evolution is clearly shown by the innumerable reports aiming to further extend inclusion criteria for LT in HCC patients. Nonetheless, the vast majority of papers only deals with morphologic (tumour diameter and number) and (only recently) biologic (tumour markers and response to locoregional treatment) parameters to do so. Curiously enough, the role of both the immune competent state of the recipient as well as the impact of both immunosuppression (IS) type and load has been very poorly addressed in this context, even if it has been shown for a long time, based on both basic and clinical research, that they all play a key role in the outcome of any oncologic treatment and in the development of de novo as well as recurrent tumours. This chapter aims to give, after a short introductive note about the currently used inclusion criteria of HCC patients for LT and about the role of IS in carcinogenesis, a comprehensive overview of the actual literature related to the impact of different immunosuppressive drugs and schemes on outcome of LT in HCC recipients. Unfortunately, up to now solid conclusions cannot be drawn due to the lack of high-level evidence studies caused by the heterogeneity of the studied patient cohorts and the lack of prospectively designed and randomized studies. Based on long-term personal experience with immunosuppressive handling in LT some proposals for further clinical research and practice are put forward. The strategy of curtailing and minimising IS should be explored in the growing field of transplant oncology taking thereby into account the immunological privilege of the liver allograft. These strategies will become more and more compelling when further extending the indications in which adjuvant chemotherapy will probably become an inherent part of the therapeutic scheme of HCC liver recipients.

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“…Several inflammatory and oxidative stress mechanisms have been implicated in linking cancer with CKD [18, 19]. End-stage renal disease patients on dialysis or after transplantation are high-risk groups identified for cancer development due to uremia and immunodeficiency [20–23]. But, research on cancer and its impact on mortality and renal outcome is scarce in a Caucasian population with advanced CKD (CKD-3-5, not on dialysis) and the question of whether the presence of cancer accelerates the rate of progression of CKD is unexplored, which this study aims to address.…”

Section: Introductionmentioning

confidence: 99%

Cancer patterns and association with mortality and renal outcomes in non-dialysis dependent chronic kidney disease: a matched cohort study

et al. 2019

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BackgroundCancer in patients with chronic kidney disease (CKD) is an added burden to their overall morbidity and mortality. Cancer can be a cause or an effect of CKD. In CKD patients, a better understanding of cancer distribution and associations can aid in the proper planning of renal replacement therapy (RRT) and in the choice of chemotherapeutic agents, many of which are precluded in more advanced CKD. This study aims to investigate the distribution and the association of cancer with mortality, renal progression and RRT assignment in a non-dialysis dependent CKD cohort, few studies have investigated this in the past.MethodsThe study was carried out on 2952 patients registered in the Salford Kidney Study (SKS) between October 2002 and December 2016. A comparative analysis was performed between 339 patients with a history of cancer (previous and current) and 2613 patients without cancer at recruitment. A propensity score matched cohort of 337 patients was derived from each group and used for analysis. Cox-regression models and Kaplan-Meier estimates were used to compare the association of cancer with mortality and end-stage renal disease (ESRD) outcomes. Linear regression analysis was applied to generate the annual rate of decline in estimated glomerular filtration rate (delta eGFR).ResultsOf our cohort, 13.3% had a history of cancer at recruitment and the annual rate of de novo cancers in the non-cancer patients was 1.6%. Urogenital cancers including kidney and bladder, and prostate and testicle in males, ovary and uterus in females, were the most prevalent cancers (46%), as expected from the anatomical or physiological roles of these organs and relationship to nephrology. Over a median follow-up of 48 months, 1084 (36.7%) of patients died. All-cause mortality was higher in the previous and current cancer group (49.6% vs 35%, p < 0.001), primarily because of cancer-specific mortality. Multivariate Cox regression analysis showed a strong association of cancer with all-cause mortality (HR:1.41; 95%CI: 1.12–1.78; p = 0.004). There was no difference between the groups regarding reaching end-stage renal disease (26% in both groups) or the rate of decline in eGFR (− 0.97 for cancer vs − 0.93 mL/min/year for non-cancer, p = 0.93). RRT uptake was similar between the groups (17.2% vs 19.3%, p = 0.49).ConclusionsCancer status proved to be an added burden and an independent risk factor for all-cause mortality but not for renal progression. CKD patients with a previous or current history of cancer should be assessed on a case by case basis in planning for renal replacement therapy options, and the presence of cancer should not be a limitation for RRT provision including transplantation.

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De novo cancer in patients on dialysis and after renal transplantation: north-western Italy, 1997–2012

Abstract: Our study confirms the increased risk of cancer after transplantation and during dialysis, but showed that virus-related cancers only occur after post-transplant immunosuppression.

Cited by 25 publications

References 16 publications

Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy

Increased cancer risk in patients undergoing dialysis: a population-based cohort study in North-Eastern Italy

Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?

Cancer patterns and association with mortality and renal outcomes in non-dialysis dependent chronic kidney disease: a matched cohort study

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