紅血球生成素對末期腎病和早期尿路上皮癌患者的影響：真實世界研究

劉惠瑛¹、羅浩倫¹、張殷綸¹、吳彥廷¹、王弘仁¹、莊燿吉¹、陳彥達¹、沈元琦¹、李文欽²、黃鏘綺²

¹高雄長庚泌尿科

²高雄長庚腎臟科

Impact of erythropoiesis-stimulating agents on patients with end stage renal disease and early-stage urothelial carcinoma: A real-world study

Hui-Ying Liu¹, Hao Lun Luo¹, Yin Lun Chang¹, Yen Ting Wu¹, Hung Jen Wang¹, Yao Chi Chuang¹, Yen Ta Chen¹, Yuan-Chi Shen¹, Wen-Chin Lee², Chiang-Chi Huang²*

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

²Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract

Purpose

In patients with end-stage renal disease (ESRD), increased risks of urothelial cancer (UC) as well as anemia are noted. Erythropoiesis-stimulating agents (ESA) improve hemoglobin (Hgb) levels in patients with ESRD with a history of UC, but their use raises concerns about cancer recurrence.

Materials and Methods

Data were collected from patients with ESRD and non-muscle-invasive bladder cancer (NMIBC) or patients with ESRD and localized upper urinary tract urothelial carcinoma (UTUC) between January 2005 and December 2019 from the Chang-Gung Research Database (CGRD). Inverse probability of treatment weighting (IPTW) analysis was performed for data analysis.

Results

A total of 496 patients with ESRD and NMIBC underwent transurethral resection of bladder tumor (TURBT), and 481 patients with ESRD and localized UTUC underwent radical nephroureterectomy (RNU) were included. In patients with ESRD and NMIBC or localized UTUC, there was no significant difference between bladder recurrence, CSS, and OS between ESA or non-ESA using groups. Although there was a trend towards higher contralateral recurrence in the ESA group in localized UTUC, none of them reached significance

.Conclusions

The use of ESA in patients with ESRD and early-stage UC, including NMIBC and localized UTUC is safe in clinical practice. No increased risks of bladder recurrence, cancer-specific mortality, or overall mortality were observed.