title: Prognosis and characteristics of renal cell carcinoma in hemodialysis patients: bilateral occurrence does not influence cancer-specific survival.
abstract: OBJECTIVE
  To compare characteristics and prognosis unilateral and bilateral renal cell carcinoma (RCC) in hemodialysis (HD) patients.
  
  
  METHODS
  Overall 246 HD patients who had undergone a radical nephrectomy for RCC were enrolled in this study. Unilateral RCC occurred in 201 patients, synchronous bilateral RCC in 15 and metachronous bilateral RCC in 30. Cancer-specific survival (CSS) was accessed by the Kaplan-Meier method.
  
  
  RESULTS
  Five-year CSS was not significantly different between the two groups (unilateral, 90%; bilateral, 90%; P=0.9509). In total 17 of the 201 patients (8.5%) with unilateral occurrence and four of the 45 patients (8.9%) with bilateral occurrence died from kidney cancer during the follow-up period. The presence of acquired cystic disease of kidney (unilateral, 73%; bilateral 91%; P=0.00319) and the mean duration of HD before surgery (unilateral: 157±91 months, bilateral: 189±83.5, P = 0.0319) were significantly different between the two groups. There were more multifocal tumors in bilateral than in unilateral occurrence (bilateral: 74%, unilateral: 30%, P<0.0001). There were significant differences in CSS according to HD duration before surgery (5-year CSS >180 months 82%, ≤180 months 95%; P=0.0004), tumor grade (G1 100%, G2 90%, G3 38%; P<0.0001), and tumor size (>4 cm 75%, ≤4 cm 98%; P<0.0001).
  
  
  CONCLUSIONS
  The type of occurrence of RCC, unilateral or bilateral, in HD patients does not appear to influence CSS. Patients with a longer duration of HD have to be followed up rigorously because they tend to have poor cancer prognosis.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. himmeno1192@yahoo.co.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Takagi
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.forename: Jyunpei
authors.initials: J
authors.lastname: Izuka
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Eri
authors.initials: E
authors.lastname: Tomita
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D052177:Kidney Diseases, Cystic / Q000150:complications; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009378:Neoplasms, Multiple Primary / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult