Lower eGFR associated with increased risk for renal, urothelial cancer

Issue: March 10, 2012

2012 ASCO Genitourinary Cancers Symposium

Patients being treated for severe chronic kidney disease are at increased risk for urothelial and renal cancer as their estimated glomerular filtration rate declines, according to results from a population-based cohort of 1.2 million adults.

Risk was greatest for patients with an eGFR of less than 30 mL/min/1.73 m2. Researchers found no significant multivariable association between prostate, colorectal, lung and breast cancer.

“As eGFR decreases, the adjusted hazard ratio or risk substantially increases in a graded fashion. For patients with an eGFR of less than 30, they had a 200% increase risk for renal cancer,” said William Thomas Lowrance, MD, MPH, assistant professor at the University of Utah School of Medicine. “For urothelial cancer, and we did not hypothesize this, we see a similar relationship. Equally important, when we look at any cancer diagnosis or specific cancers — prostate, breast, lung and colorectal — we do not see any significant increased risk as eGFR decreases. This counters what some earlier work has shown.”

Lowrance and colleagues reviewed data on nearly 1.2 million patients with no prior dialysis, renal transplant or known cancer who underwent treatment within the Kaiser Permanente Northern California health system from 2000 to 2008. Records were evaluated for an independent association between eGFR and the risk cancer — overall and by type.

There were 76,809 incident cancer diagnoses among 72,875 patients during more than 6 million person-years of follow-up.

After adjusting for possible confounding factors, researchers found that risk for renal cancer increased in inverse proportion with eGFR: HR=1.35 (95% CI, 1.18-1.55) for eGFR of 45 to 59 mL/min/1.73 m2; HR=1.65 (95% CI, 1.37-1.97) for eGFR of 30 to 44 mL/min/1.73 m2; and HR=2.09 (95% CI, 1.62-2.70) for eGFR of less than 30 mL/min/1.73 m2.
Patients were at similar increased risk for urothelial cancer if their eGFR ranged from 30 to 44 mL/min/1.73 m2 (HR=1.40; 95% CI, 1.18-1.67) or was less than 30 mL/min/1.73 m2 (HR=1.35; 95% CI, 1.04-1.74).

“Estimated GFR may play a role in identifying patients at higher risk for renal or urothelial malignancies,” Lowrance said. “Prospective studies are needed to further assess the net clinical benefit of targeted cancer screening in patients with chronic kidney disease to elucidate the etiology of this association.”

For more information:

Lowrance WT. Abstract #351. Presented at: ASCO Genitourinary Cancers Symposium; Feb. 2-4, 2012; San Francisco.

Disclosure: Dr. Lowrance reports no relevant financial disclosures.

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