title: Death Does Matter--Cancer Risk in Patients With End-Stage Renal Disease: A Nationwide Population-Based Study With Competing Risk Analyses.
abstract: Patients with end-stage renal disease (ESRD) have a high mortality rate. We hypothesized that not accounting for death as a competing risk overestimates the event rate caused by ESRD. Thus, we examined the cancer risk for patients with ESRD (ESRD) after death as a competing risk event had been adjusted for. Patients with newly diagnosed ESRD (n = 64,299) between 1999 and 2007, together with age- and sex-matched controls without ESRD (ESRD) (n = 128,592) were enrolled (1:2). In a Cox proportional hazards model that included death as a competing risk, ESRD patients in Taiwan had a lower overall incidence (subdistribution hazard ratio [sdHR] = 1.29) of cancer than did ESRD patients in a Cox model that did not include death as a competing risk (HR = 1.70). After competing mortality had been adjusted for, ESRD patients ≥70 (sdHR = 0.82) and ESRD patients on long-term dialysis (> 5 follow-up years, sdHR = 0.62), had a lower risk for developing cancer than did ESRD patients. This finding supported our hypothesis that standard survival analyses overestimate the event rate, especially when the mortality rate is high. It also showed that ESRD patients, when they grow older, were far less likely to develop cancer and far more likely to die because of underlying illnesses that might also affect the risk of death because of ESRD.
authors.affiliation: From the Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung (S-FW, Y-HC); Department of Pediatrics, Chi Mei Medical Center, Liouying (R-LJ); Graduate Institute of Clinical Medicine, National Cheng Kung University (R-LJ); Department of Medical Research (Y-CC); Department of Nephrology, Chi-Mei Medical Center (C-CC); Department of Food Nutrition, Chung Hwa University of Medical Technology (C-CC); Department of Anesthesiology, Chi-Mei Medical Center (J-JW, C-CC); and Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan (C-CC).
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Chiu
authors.forename: Ren-Long
authors.initials: RL
authors.lastname: Jan
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Chen
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Chu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
references.citation: J Clin Epidemiol. 2006 Oct;59(10):1110-4
references.pmid: 16980152
references.citation: Jpn J Clin Oncol. 2011 Jun;41(6):752-7
references.pmid: 21515610
references.citation: Jpn J Clin Oncol. 2012 Sep;42(9):780-6
references.pmid: 22782961
references.citation: J Viral Hepat. 2010 Jan;17(1):59-64
references.pmid: 19566787
references.citation: J Korean Med Sci. 2009 Jan;24 Suppl:S95-S101
references.pmid: 19194570
references.citation: Clin Cancer Res. 2004 Mar 15;10(6):1956-62
references.pmid: 15041712
references.citation: J Intern Med. 2006 Sep;260(3):255-62
references.pmid: 16918823
references.citation: Stat Med. 2007 May 20;26(11):2389-430
references.pmid: 17031868
references.citation: Nephrol Dial Transplant. 2012 Apr;27(4):1585-90
references.pmid: 21862456
references.citation: Am J Epidemiol. 1998 Nov 15;148(10):1012-7
references.pmid: 9829874
references.citation: J Gastroenterol Hepatol. 2007 Jan;22(1):92-8
references.pmid: 17201888
references.citation: Clin Nephrol. 1988;30 Suppl 1:S37-40
references.pmid: 3052959
references.citation: J Hepatol. 2006 Oct;45(4):529-38
references.pmid: 16879891
references.citation: JAMA. 2006 Dec 20;296(23):2823-31
references.pmid: 17179459
references.citation: Stat Med. 2013 Aug 15;32(18):3077-88
references.pmid: 23436643
references.citation: Am J Kidney Dis. 2007 Jan;49(1):46-55
references.pmid: 17185145
references.citation: Comput Methods Programs Biomed. 2015 Feb;118(2):218-33
references.pmid: 25572709
references.citation: J Am Soc Nephrol. 2003 Jan;14(1):197-207
references.pmid: 12506152
references.citation: Cancer. 2007 Apr 15;109(8):1487-92
references.pmid: 17330839
references.citation: Lancet. 1999 Jul 10;354(9173):93-9
references.pmid: 10408483
references.citation: J Nephrol. 2008 Mar-Apr;21(2):166-74
references.pmid: 18446710
references.citation: Br J Cancer. 2004 Oct 4;91(7):1229-35
references.pmid: 15305188
references.citation: Nephrol Dial Transplant. 2009 Oct;24(10):3225-31
references.pmid: 19589786
references.citation: Proc Eur Dial Transplant Assoc. 1981;18:724-30
references.pmid: 7329999