Christian F Christiansen1, Tracy Onega2, Claus Sværke3, Dóra Körmendiné Farkas3, Bente Jespersen4, John A Baron5, Henrik Toft Sørensen3. 1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: cfc@clin.au.dk. 2. Departments of Medicine and Community and Family Medicine and the Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, NH. 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 4. Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, University of North Carolina, Chapel Hill.
Abstract
BACKGROUND: Nephrotic syndrome may be a marker of occult cancer, but population-based studies of this association are lacking. Therefore, we examined the risk and prognosis of cancer in patients with nephrotic syndrome. METHODS: We conducted this population-based cohort study in Denmark, including all individuals diagnosed with nephrotic syndrome between 1980 and 2010 without a preceding cancer history. We computed the 5-year risk of cancer accounting for competing risk by death and standardized incidence ratios (SIRs) of cancer in patients with nephrotic syndrome relative to the general population. We compared the 5-year mortality for patients with cancer after nephrotic syndrome with that for a cancer cohort without a history of nephrotic syndrome using Cox regression adjusted for age, gender, and comorbidity. RESULTS: Of 4293 individuals with nephrotic syndrome, 338 developed an incident cancer during a median follow-up of 5.7 years. The 5-year risk of any cancer was 4.7% in patients with nephrotic syndrome, a 73% increased risk (SIR, 1.73; 95% confidence interval [CI], 1.55-1.92). The association was most pronounced for lung cancer, kidney cancer, lymphoma, and multiple myeloma. It was highest within 1 year of nephrotic syndrome diagnosis (SIR, 4.49; 95% CI, 3.68-5.42), but remained increased beyond 1 year (SIR, 1.34; 95% CI, 1.17-1.53). The 5-year mortality after cancer was 68.5% in patients with cancer with nephrotic syndrome and 63.4% in the cancer comparison cohort (adjusted hazard ratio, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS: Nephrotic syndrome is a marker of occult solid tumors and hematologic malignancies and is associated with a worsened cancer prognosis.
BACKGROUND:Nephrotic syndrome may be a marker of occult cancer, but population-based studies of this association are lacking. Therefore, we examined the risk and prognosis of cancer in patients with nephrotic syndrome. METHODS: We conducted this population-based cohort study in Denmark, including all individuals diagnosed with nephrotic syndrome between 1980 and 2010 without a preceding cancer history. We computed the 5-year risk of cancer accounting for competing risk by death and standardized incidence ratios (SIRs) of cancer in patients with nephrotic syndrome relative to the general population. We compared the 5-year mortality for patients with cancer after nephrotic syndrome with that for a cancer cohort without a history of nephrotic syndrome using Cox regression adjusted for age, gender, and comorbidity. RESULTS: Of 4293 individuals with nephrotic syndrome, 338 developed an incident cancer during a median follow-up of 5.7 years. The 5-year risk of any cancer was 4.7% in patients with nephrotic syndrome, a 73% increased risk (SIR, 1.73; 95% confidence interval [CI], 1.55-1.92). The association was most pronounced for lung cancer, kidney cancer, lymphoma, and multiple myeloma. It was highest within 1 year of nephrotic syndrome diagnosis (SIR, 4.49; 95% CI, 3.68-5.42), but remained increased beyond 1 year (SIR, 1.34; 95% CI, 1.17-1.53). The 5-year mortality after cancer was 68.5% in patients with cancer with nephrotic syndrome and 63.4% in the cancer comparison cohort (adjusted hazard ratio, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS:Nephrotic syndrome is a marker of occult solid tumors and hematologic malignancies and is associated with a worsened cancer prognosis.
Authors: Anna Kolb; Peter J Gallacher; Jacqueline Campbell; Martin O'Neill; James R Smith; Samira Bell; Bryan R Conway; Wendy Metcalfe; Nicola Joss; Vishal Dey; Annette Alfonzo; Michael Kelly; Shahzad Shah; Emily McQuarrie; Colin Geddes; Jamie Traynor; Robert W Hunter Journal: Kidney Int Rep Date: 2020-11-04