title: Analysis of potential risk factors for cancer incidence in patients with aristolochic acid nephropathy from Wenzhou, China.
abstract: BACKGROUND
  The purpose of this study was to investigate the cancer incidence in patients with end-stage aristolochic acid nephropathy (AAN).
  
  
  METHODS
  A total of 102 patients with end-stage AAN treated in our hospital between 2004 and 2013 were included in this study. The correlation of cancer incidence with age, gender, dosage of aristolochic acid (AA), the type of renal replacement therapies, and the polymorphisms of quinone oxidoreductase 1 (NQO1) C609T and cytochrome P450 1A1 (CYP1A1) A4889G was examined.
  
  
  RESULTS
  The cancer incidence rate in our patients was 41.2% (42 in 102) including 39 cases of urinary cancer. The mortality rate in the patients with cancer was significantly higher than that in the patients without cancer (31%, 13/42 vs. 11.7%, 7/60, p<0.05). Thirteen patients developed cancer before entering end-stage renal disease (ESRD). Cancer incidence was significantly associated with the dosage of AA consumption (p=0.091). Hemodialysis, peritoneal dialysis and renal transplant did not affect the cancer incidence in our patients differently, but appeared to be associated with cancer at particular locations of urinary system. The patients undergoing hemodialysis seemed to more likely have bladder cancer (72.72%), while the patients receiving peritoneal dialysis appeared to develop cancer predominantly in the upper urinary tract (66.67%).
  
  
  CONCLUSIONS
  The cancer initiation in our patients seems significantly correlate with the dosage of AA consumption. Different renal replacement therapies appear to be associated with cancer at particular locations of urinary system in our patients.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Sun
authors.forename: Jianna
authors.initials: J
authors.lastname: Zhang
authors.forename: Chenfei
authors.initials: C
authors.lastname: Zheng
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.forename: Fan
authors.initials: F
authors.lastname: Lin
authors.forename: Feifei
authors.initials: F
authors.lastname: Xu
authors.forename: Chaosheng
authors.initials: C
authors.lastname: Chen
mesh_terms: D000368:Aged; D034341:Aristolochic Acids / Q000009:adverse effects / Q000493:pharmacokinetics; D002273:Carcinogens / Q000493:pharmacokinetics; D002681:China / Q000453:epidemiology; D019363:Cytochrome P-450 CYP1A1 / Q000032:analysis; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016660:NAD(P)H Dehydrogenase (Quinone) / Q000032:analysis; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D034341:Aristolochic Acids; D002273:Carcinogens; C000228:aristolochic acid I; C569463:CYP1A1 protein, human; D019363:Cytochrome P-450 CYP1A1; D016660:NAD(P)H Dehydrogenase (Quinone); C447479:NQO1 protein, human
keywords: Aristolochic acid; cancer in urinary system; renal replacement therapy