Appraisal of lung cancer survival in patients with end-stage renal disease

Ming-Shian Lu; Miao-Fen Chen; Yao-Hsu Yang; Chuan-Pin Lee; Chien-Chao Lin; Yuan-Hsi Tseng; Ying-Huang Tsai

doi:10.5114/aoms.2019.86783

Appraisal of lung cancer survival in patients with end-stage renal disease

Arch Med Sci. 2019 Jul 22;19(1):86-93. doi: 10.5114/aoms.2019.86783. eCollection 2023.

Authors

Ming-Shian Lu¹, Miao-Fen Chen², Yao-Hsu Yang³, Chuan-Pin Lee³, Chien-Chao Lin¹, Yuan-Hsi Tseng¹, Ying-Huang Tsai^{4

5}

Affiliations

¹ Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, ChiaYi, Taiwan.
² Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan and Chang Gung University, College of Medicine, ChiaYi, Taiwan.
³ Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, ChiaYi, Taiwan.
⁴ Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, ChiaYi, Taiwan.
⁵ Department of Respiratory Therapy, Chang Gung University, Taiwan.

Abstract

Introduction: The survival outcome of lung cancer patients with end-stage renal disease has been poorly studied in the literature. In this study, we evaluated the effect of end-stage renal disease on lung cancer survival.

Material and methods: A retrospective, multicenter, matched-cohort study of lung cancer patients with end-stage renal disease under renal replacement therapy (WITH-ESRD) and without end-stage renal disease (WITHOUT-ESRD) was performed. One WITH-ESRD patient was matched to four WITHOUT-ESRD patients.

Results: Baseline clinical characteristics did not differ statistically significantly after matching between the WITH-ESRD and WITHOUT-ESRD groups. WITH-ESRD included 133 patients and WITHOUT-ESRD included 532 patients. Kaplan-Meier survival analysis demonstrated no significant difference in median overall survival between WITH-ESRD patients and WITHOUT-ESRD patients (7.36 months versus 12.25 months, respectively, p = 0.133). Lung cancer WITH-ESRD patients receiving medical treatment had a median overall survival of 5.98 months (95% CI: 4.34-11.76) compared to 14.13 months (95% CI: 11.30-16.43) for WITHOUT-ESRD patients, p = 0.019. Although patients receiving surgical treatment compared to those receiving medical treatment had an improvement of survival by 46% (HR = 0.54, 95% CI: 0.19-1.53, p = 0.243), the difference did not reach statistical significance. Cox regression analysis revealed that male gender and stage IIIA-IV were independent factors associated with poor outcome for WITH-ESRD patients.

Conclusions: In our limited experience, the survival for lung cancer with ESRD is not inferior to lung cancer patients without ESRD. The reasons for poor survival for the WITH-ESRD medical treatment group and late diagnosis despite frequent medical visits merit further investigation.

Keywords: end-stage renal disease; lung cancer; survival.