BERKELEY, CA (UroToday.com) - It is well established that patients with end-stage renal disease (ESRD) demonstrate a significantly greater risk for renal cell carcinoma (RCC) compared to the general population. Additionally, following surgical extirpation, there is a typical waiting period prior to transplantation to ensure there is no disease recurrence. While there have been many reports attempting to determine the incidence of RCC in the ESRD population, the actual clinical significance and prognosis of RCC in this population has not been adequately addressed.
In our study, we retrospectively compared pathological and clinical outcomes in a cohort of patients with RCC with and without ESRD. There were 95 cases in the ESRD cohort and 243 cases of RCC without ESRD. In our series, ESRD patients had decreased risk of clear cell RCC, smaller mean tumor size, lower pathologic T-stage, less risk of metastasis, and lower Karakiewicz nomogram scores, suggesting that patients with ESRD who develop RCC have a better overall prognosis. There was no significant difference in cancer specific mortality or overall mortality between the two groups, likely secondary to the patients in the ESRD group being less healthy subjects at baseline. The most notable finding in our series was the decreased risk of recurrence in ESRD patients compared to the general population. In our cohort, the patients with ESRD had 1/10th the risk of tumor recurrence compared to the patients without ESRD, likely a combination of a favorable histologic phenotype as well as the likelihood of early diagnosis in these patients, having been screened for possible transplantation. Our data suggest that the standard delay between nephrectomy and renal transplantation may be reduced and should be further evaluated, especially in patients with asymptomatic, low-grade tumors.
Adam Shrewsberry, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Emory University, Atlanta, GA USA