慢性肾病可增加癌症风险

拉斯维加斯——在美国国立肾脏基金会主办会议上公布的一项回顾性分析结果显示，慢性肾病患者发生癌症的风险增加。

这项分析由克利夫兰凯斯西储大学医学系的Dhruti P. Chen博士及其同事进行，分析对象为来自ALLHAT（the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial）研究的31,896例入组患者。

Dhruti P. Chen博士

结果显示，在研究期间的平均随访4.9年间，有2,529例患者被诊断患有各种癌症。在基线正常估计肾小球滤过率（eGFR）＞90 mL/min/1.73 m²的患者中，偶发性癌症的5年发生率为7.24例/ 100人-年。癌症发生率随肾功能降低而增加：在基线eGFR为60~89.9 mL/min/1.73 m²的患者中为8.38例/100人-年，在eGFR为45~59.9 mL/min/1.73 m²的患者中为9.18例/100人-年，在eGFR＜45 mL/min/1.73 m²的患者中为11.58例/100人-年。

在ALLHAT研究结束后，通过国家数据库对癌症所致死亡进行额外4年随访。在平均总共8.9年随访期间，发生2,338例癌症相关死亡。10年癌症死亡率在eGFR＞90 mL/min/1.73 m²的患者中为7.90例/100人-年，在eGFR为60~89.9 mL/min/1.73 m²的患者中为7.71例/100人-年，在eGFR为45~59.9 mL/min/1.73 m²的患者中为10.11例/100人-年，在eGFR＜45 mL/min/1.73 m²的患者中为13.19例/100人-年。

在校正人口统计学特征、身体质量指数、糖尿病、心血管危险因素、血糖水平和患者随机接受的抗高血压药的多因素分析中，发现慢性肾病与偶发性癌症之间的关联程度减弱。然而，与基线eGFR＞90 mL/min/1.73 m²相比，基线eGFR＜45 mL/min/1.73 m²与校正后随访4.9年间偶发性癌症风险增加28%和随访8.9年间癌症死亡风险增加55%独立相关。

结肠癌是在慢性肾病患者中观察到的发生率显著增加的唯一常见型恶性肿瘤，但鉴于观察到的癌症例数有限，Chen博士不认为这一结果具有重要意义。

Chen博士在接受采访时表示，此类事后分析不能确立因果关系和所涉及的机制。在慢性肾病患者中观察到的癌症风险增加的结果最可能是缘于肾功能损害患者体内的各种毒素未被完全清除，而其中一些毒性具有致癌性。

ALLHAT研究获美国国立心肺和血液研究所资助。Chen博士声明无经济利益冲突。

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By: BRUCE JANCIN, Oncology Practice Digital Network

AT SCM 14

VITALS

Major finding: Patients with chronic kidney disease had an adjusted 55% increased risk of cancer-related mortality during a mean 8.9 years of prospective follow-up, compared with those with normal kidney function.

Data source: This was a post hoc analysis of 31,896 participants in the prospective ALLHAT study.

Disclosures: ALLHAT was funded by the National Heart, Lung, and Blood Institute. The presenter reported having no financial conflicts of interest.

LAS VEGAS – Patients with chronic kidney disease appear to be at increased risk for cancer, a study showed.

A retrospective analysis of data on 31,896 participants in ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) showed that during a mean 4.9 years of in-trial follow-up, 2,529 subjects were diagnosed with various cancers.

An additional 4 years of follow-up for mortality due to cancer was available through national databases after ALLHAT ended. During the mean total 8.9 years of follow-up, there were 2,338 cancer-related deaths. The 10-year rate of cancer mortality was 7.90 cases per 100 person-years in patients with an eGFR greater than 90; 7.71 in those with an eGFR of 60-89.9; 10.11 per 100 person-years with an eGFR of 45-59.9; and 13.19 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m2, added Dr. Chen of the department of medicine at Case Western Reserve University, Cleveland.The 5-year rate of incident cancer was 7.24 cases per 100 person-years among subjects with a baseline normal estimated glomerular filtration rate (eGFR) greater than 90 mL/min per 1.73 m2. The cancer rate rose with decreasing renal function: 8.38 cases per 100 person-years in patients with a baseline eGFR of 60-89.9, 9.18 per 100 person-years in those with an eGFR of 45-59.9, and 11.58 per 100 person-years in patients with an eGFR below 45 mL/min per 1.73 m2, Dr. Dhruti P. Chen reported at a meeting sponsored by the National Kidney Foundation.

In a multivariate analysis adjusted for demographics, body mass index, diabetes, cardiovascular risk factors, blood glucose level, and the antihypertensive agent to which a patient was randomized, the association between chronic kidney disease and incident cancer was attenuated. Nonetheless, having a baseline eGFR below 45 mL/min per 1.73 m2 was independently associated with an adjusted 28% increased risk of incident cancer during 4.9 years of follow-up, compared with those with an eGFR greater than 90, as well as with a 55% increased risk of cancer mortality during 8.9 years of follow-up.

Colon cancer was the only common type of malignancy whose incidence was significantly increased in patients with chronic kidney disease, although Dr. Chen said she didn’t attach much significance to this finding, given the limited number of cancers that accrued.

In an interview, she observed that a post hoc analysis such as this can’t establish causality or the mechanisms involved. She speculated that the most likely explanation for the findings is that patients with impaired kidney function have incomplete removal of various toxins, some of which are oncogenic.

ALLHAT was funded by the National Heart, Lung, and Blood Institute. Dr. Chen reported having no financial conflicts of interest.