title: Renal cell carcinoma in patients with end-stage renal disease is associated with more favourable histological features and prognosis.
abstract: OBJECTIVE
  End-stage renal disease (ESRD) patients with acquired cystic kidney disease are at higher risk of developing renal cell carcinoma (RCC) than the general population. The aim of this study was to investigate the clinical and histopathological differences between ESRD patients and the general population with RCC.
  
  
  METHODS
  Data were retrospectively collected from all nephrectomies performed for localized RCC from 2000 to 2010. Age at nephrectomy, gender, race, symptoms, baseline Eastern Cooperative Oncology Group (ECOG) performance status, Charlson Comorbidity Index score and histological data were extracted. Independent-samples t test and Mann-Whitney test were used for quantitative data, while chi-squared (two-sided) and Fisher's exact tests were used for qualitative data.
  
  
  RESULTS
  This study included 627 patients: 73 with and 554 without ESRD. The majority of patients were Chinese. The male to female ratio of 2:1 was identical in both groups. Baseline ECOG performance status and Charlson Comorbidity score were higher in the ESRD group. RCC in ESRD patients was more frequently asymptomatic (56.2% vs 44.9%, p = 0.071), diagnosed earlier (53.6 ± 11.8 years vs 57.9 ± 12.2 years, p = 0.004) and of lower stage (p < 0.001). The ESRD cohort had a higher proportion of the papillary histological subtype (21.9% vs 9.7%, p < 0.001). Importantly, there was a trend towards more favourable outcomes in ESRD patients in terms of cancer-specific (p = 0.203) and relapse-free survival (p = 0.096).
  
  
  CONCLUSIONS
  This study suggests that RCC in ESRD patients is associated with more favourable clinical and histological features and oncological outcome compared with that in patients with normal renal function.
authors.affiliation: Departments of Urology.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chen
authors.forename: Hong Hong
authors.initials: HH
authors.lastname: Huang
authors.forename: Hakan
authors.initials: H
authors.lastname: Aydin
authors.forename: Yeh Hong
authors.initials: YH
authors.lastname: Tan
authors.forename: Weber K O
authors.initials: WK
authors.lastname: Lau
authors.forename: Christopher W S
authors.initials: CW
authors.lastname: Cheng
authors.forename: John S P
authors.initials: JS
authors.lastname: Yuen
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Clear cell; end-stage renal disease; outcome; papillary; renal cell carcinoma