Increased risk for renal cell carcinoma in end stage renal disease – a population-based case-control study

Abstract

Purpose

End-stage renal disease (ESRD) is a known risk factor for the development of renal cell carcinoma (RCC). This case-control study was performed to assess the risk in a nationwide cohort and evaluate tumor characteristics and survival in the ESRD-RCC population.

Methods

In this study, 9,299 patients with RCC identified in the National Swedish Kidney Cancer Register from 2005 until 2014 and 93,895 matched controls were linked to the Swedish Renal Registry and the National Patient Register. ESRD was defined as chronic kidney disease stage 5, kidney transplantation or kidney dialysis 0–40 years before the diagnosis of RCC.

Results

A total of 117 patients with ESRD and subsequent RCC were identified and compared with 9,087 patients with RCC. There was a 4.5-times increased risk for RCC among ESRD patients (95% CI = 3.6–5.6; p < 0.001) compared to matched controls. Longer time with ESRD increased the risk of RCC (ESRD > 9 years, OR = 10.2, 95% CI = 7.0–14.8). The ESRD-RCC patients were younger (p = 0.002), had smaller tumors (p < 0.001) and had lower tumor stage (p = 0.045). The incidence of papillary and chromophobe RCC was higher and clear cell RCC lower among the ESRD patients (p < 0.001). The 5-year overall survival was 50% in ESRD-RCC patients and 63% in RCC-only patients (p < 0.05).

Conclusion

More than 9 years with ESRD increased the risk of developing RCC 10-times compared to individuals without ESRD and the tumors showed a different histopathological pattern. Despite a less advanced tumor stage at diagnosis, the overall survival in ESRD-RCC patients was lower compared to patients with RCC-only.

Keywords:

• Renal cell carcinoma
• end-stage renal disease
• pathology
• survival

Acknowledgements

Many thanks to the NSKCR steering panel for the continuous work with the National Swedish Kidney Cancer Register. Moreover, the authors are grateful to the people and the work behind RCCBaSe and their register-design and setting in the database. Lastly, a special thanks to Magnus Öberg at Registercentrum Norr for skillful data management of the database.

Ethical approval

The study was performed after approval of the regional Ethic review board of northern Sweden. Dnr: 2012-418-31M and 2014-301-32M.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was possible with the support from the Märtha and Gustaf Ågren’s research Foundation, the Foundation of Anna-Lisa and Bror Björnsson, the Research Foundation at the Urology Department of Sahlgrenska University Hospital and government grants under the project ALF at Sahlgrenska University Hospital [project no. 75770].