Difference among races in posttransplant malignancies: report from an oriental country

Increased upper and lower tract urothelial carcinoma in patients with end-stage renal disease: a nationwide cohort study in Taiwan during 1997-2008

Background. Urothelial cancer (UC) is the leading cancer of patients with end-stage renal disease (ESRD) in Taiwan. The aims of this study were to explore the time trends of UC incidences and propose possible etiologic factors. Methods. Abstracting from the National Health Insurance Research Database (NHIRD), there were 90,477 newly diagnosed cases of ESRD between 1997 and 2008 covering the patients aged 40–85. Among them, 2,708 had developed UC after diagnosis of ESRD. The CIR_40–85 (cumulative incidence rate) of upper tract UC (UTUC) and lower tract UC (LTUC) were calculated for ESRD patients and general population, as well as SIR_40–85 (standardized incidence ratio) for comparison. Results. Female ESRD patients were found to have 9–18 times of elevated risks of UC, while those of males were increased up to 4–14 times. The time trends of CIR_40–84 and SIR_40–84 of UTUC in females appear to decline after calendar year 2000. These trends may be related to AA associated herbal products after 1998. Conclusions. Patients with ESRD are at increased risks for both LTUC and UTUC in Taiwan. We hypothesize that the time trends associate with the consumption of aristolochic acid in Chinese herbal products (female predominant).

Increased risk of urothelial cancer in young and middle aged patients with end-stage renal disease

BACKGROUND/PURPOSE

End-stage renal disease (ESRD) may increase the likelihood of malignancy. The aim of this study is to evaluate the characteristics of increased urothelial cancer (UC) risk in patients with ESRD in Taiwan by a population-based study.

METHODS

The standardized incidence ratios (SIRs) for UC among a registered cohort of ESRD in Taiwan during 1997-2002 were calculated using reimbursement data obtained from the Bureau of National Health Insurance (NHI), with the incidence rates of UC in the general population as the reference.

RESULTS

During the study period we identified 58,739 patients with ESRD, 20,939 patients with UC, and 1305 patients with ERSD and UC. Among the 1305 patients with both diseases, 687 developed UC after ESRD had been diagnosed. Using the general population as the reference group, SIRs were 12.9 [95% confidence interval (CI)]: 12.0-13.9) for all UC cases, 13.9 (95% CI: 12.4-15.0) for bladder cancer, 11.9 (95% CI: 8.6-16.0) for renal cell carcinoma, and 11.6 (95% CI: 10.1-13.1) for upper tract urothelial cancer.

CONCLUSION

Patients with ESRD are at increased risk for UC in Taiwan, especially women age 50 years and younger. Early and lifelong surveillance of UC is recommended after diagnosis of ESRD.

Increased incidence of gastric cancer in renal transplant recipients

OBJECTIVE

The risk of malignancy after transplantation is regarded to be higher than in the general population. The aim of this study was to evaluate the frequency of gastric cancer in renal transplant recipients.

METHODS

A total of 820 renal transplantation recipients were invited for gastric cancer screening. Frequencies of gastric cancer in this cohort and in 10,080 asymptomatic subjects were compared. Cancer specimens were examined for Epstein-Barr virus by in situ hybridization.

RESULTS

A total of 509 recipients (mean age, 48.1 ± 10.7 y; men, 56.8%) participated. Fifteen (2.9%) and 10 (0.1%) cases of adenocarcinoma were identified among recipients and controls, respectively (P<0.001; odds ratio, 30.58). Early gastric cancer was detected in 9 of the 15 recipients, and 4 of the 9 were treated by endoscopic resection. Recipient age was found to be a significant factor of gastric cancer development. In cancer tissues, Epstein-Barr virus was detected in 5 (33.3%) renal recipients and in 1 (10%) of the controls, respectively.

CONCLUSIONS

The frequency of gastric cancer was found to be higher in renal recipients than in controls. Gastric cancer screening should be considered after transplantation, because it would provide cure by minimally invasive treatment.

Anti-rejection drug treatment increases basal cell carcinoma burden in Ptch1+/- mice

The development of extensive and severe non-melanoma skin cancer is an extremely common complication of organ transplantation and is assumed to be caused by long-term treatment with anti-rejection drugs (ARD). Despite this florid clinical problem, ARD treatments have been reported to affect experimental murine skin carcinogenesis only weakly. We report here that treatment of cesium-137-irradiated Ptch1+/- mice with immunosuppressive doses of cyclosporine A plus prednisolone for 4-1/2 mo increased basal cell carcinoma burden by 2.5-fold. Thus, these mice provide a good model for study of the effects of long-term administration of ARD on at least one type of non-melanoma skin cancer.