Abstract
Purpose
To clarify the background, clinical symptoms, pathological characteristics, and duration of survival in patients with bladder cancer on hemodialysis and to examine the appropriate treatment strategies.
Methods
Between April 1988 and May 2012, 28 patients in whom bladder cancer was diagnosed and treated after dialysis was initiated were included in this retrospective study. We examined the clinicopathological characteristics and survival.
Results
Twenty men and 8 women were included (mean age 64.1 ± 11.9 years). The mean duration of dialysis was 80.2 ± 79.1 months. The duration of follow-up after treatment was 43.9 ± 41.2 months. Fourteen patients underwent immediate total cystectomy after the diagnosis of muscle-invasive bladder cancer or high-grade pT1 tumors. Of these, four died of cancer and two had surgery-related deaths. Fourteen patients underwent transurethral resection, and the initial diagnosis was non-muscle-invasive bladder cancer. Of these, three underwent delayed total cystectomy because the time to recurrence was short or there were multiple intravesical recurrences; none died of cancer. The duration of hemodialysis tended to be longer in patients who underwent immediate total cystectomy than in those who underwent only transurethral resection or delayed total cystectomy (107.1 ± 92.0 vs. 53.3 ± 63.9 months, p = 0.10).
Conclusions
Bladder cancer in hemodialysis patients can be treated using the same strategy as for the general population. Bladder cancer in longer-term hemodialysis patients tends to be pathologically more advanced; thus, total cystectomy, although highly invasive, is often needed. Establishing bladder cancer screening for patients on dialysis is desirable.
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References
Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB et al (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354(9173):93–99
Ehdaie B, Stukenborg GJ, Theodorescu D (2009) Renal transplant recipients and patients with end stage renal disease present with more advanced bladder cancer. J Urol 182(4):1482–1487
Kato S, Chmielewski M, Honda H, Pecoits-Filho R, Matsuo S, Yuzawa Y et al (2008) Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol 3(5):1526–1533
Vamvakas S, Bahner U, Heidland A (1998) Cancer in end-stage renal disease: potential factors involved -editorial. Am J Nephrol 18(2):89–95
Matas AJ, Simmons RL, Kjellstrand CM, Buselmeier TJ, Najarian JS (1975) Increased incidence of malignancy during chronic renal failure. Lancet 1(7912):883–886
Wu CF, Pang ST, Shee JJ, Chang PL, Chuang CK, Chen CS et al (2010) Identification of genetic alterations in upper urinary tract urothelial carcinoma in end-stage renal disease patients. Genes Chromosomes Cancer 49(10):928–934
Stopper H, Schupp N, Klassen A, Sebekova K, Heidland A (2005) Genomic damage in chronic renal failure–potential therapeutic interventions. J Ren Nutr 15(1):81–86
Stewart JH, Buccianti G, Agodoa L, Gellert R, McCredie MR, Lowenfels AB et al (2003) Cancers of the kidney and urinary tract in patients on dialysis for end-stage renal disease: analysis of data from the United States, Europe, and Australia and New Zealand. J Am Soc Nephrol 14(1):197–207
Malachi T, Zevin D, Gafter U, Chagnac A, Slor H, Levi J (1993) DNA repair and recovery of RNA synthesis in uremic patients. Kidney Int 44(2):385–389
Yossepowitch O, Sagy I, Margel D, Baniel J (2012) Urothelial carcinoma of the bladder in patients on hemodialysis: clinical characteristics and oncological outcomes. J Urol 187(4):1215–1219
Wu CF, Chang PL, Chen CS, Chuang CK, Weng HH, Pang ST (2006) The outcome of patients on dialysis with upper urinary tract transitional cell carcinoma. J Urol 176(2):477–481
Wu CF, Shee JJ, Ho DR, Chen WC, Chen CS (2004) Different treatment strategies for end stage renal disease in patients with transitional cell carcinoma. J Urol 171(1):126–129
Tseng SF, Chuang YC, Yang WC (2011) Long-term outcome of radical cystectomy in ESDR patients with bladder urothelial carcinoma. Int Urol Nephrol 43(4):1067–1071
Kang CH, Chen CH, Chiang PH (2010) Primary urothelial carcinoma of the upper urinary tract in dialysis patients with 5-year follow-up. Jpn J Clin Oncol 40(3):241–246
Satoh S, Tsuchiya N, Habuchi T, Ishiyama T, Seimo K, Kato T (2005) Renal cell and transitional cell carcinoma in a Japanese population undergoing maintenance dialysis. J Urol 174(5):1749–1753
Veltman GA, Bosch FH, van der Plas-Cats MB, van Leusen R (1991) Urine cytology as a screening method for transitional-cell carcinoma in dialysis patients with analgesic nephropathy. Nephrol Dial Transplant 6(5):346–348
Hadatsuki H, Sasagawa I, Suzuki H, Yaguchi H, Mutoh A, Kubota Y et al (1998) Bladder cancer in a patient on long-term haemodialysis. Int Urol Nephrol 30(5):565–568
Lin MY, Kuo MC, Hung CC, Wu WJ, Chen LT, Yu ML et al (2015) Association of dialysis with the risks of cancers. Plos One 10(4):e0122856
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We thank Ms. Nobuko Hata for her secretarial work. There were no sources of financial grants and other funding.
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Sato, Y., Kondo, T., Takagi, T. et al. Treatment strategy for bladder cancer in patients on hemodialysis: a clinical review of 28 cases. Int Urol Nephrol 48, 503–509 (2016). https://doi.org/10.1007/s11255-015-1199-2
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DOI: https://doi.org/10.1007/s11255-015-1199-2