Appraisal of lung cancer survival in patients with end-stage renal disease
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Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, ChiaYi, Taiwan
Department of Radiation Oncology, Chang Gung Memorial Hospital, Taiwan and Chang Gung University, College of Medicine, ChiaYi, Taiwan
Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, ChiaYi, Taiwan
Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, ChiaYi, Taiwan
Department of Respiratory Therapy, Chang Gung University, Taiwan
Submission date: 2019-03-17
Final revision date: 2019-07-02
Acceptance date: 2019-07-04
Online publication date: 2019-07-22
Arch Med Sci 2023;19(1)
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.

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.

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.