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Abstract：
BACKGROUND: Cancer is a major cause of death in patients undergoing haemodialysis. However, information about the actual clinical practice of chemotherapy for patients with cancer undergoing haemodialysis is lacking. We conducted a nationwide survey using questionnaires on the clinical practice of chemotherapy for such patients.
METHODS: The nationwide survey included patients undergoing haemodialysis who were subsequently diagnosed with cancer in 20 hospitals in Japan from January 2010 to December 2012. We reviewed their clinical data, including cancer at the following primary sites: kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast. The questionnaires consisted of the following subjects: (1) patient characteristics; (2) regimen, dosage and timing of chemotherapy; and (3) clinical outcome.
RESULTS: Overall, 675 patients were registered and assessed for main primary cancer site involvement. Of 507 patients with primary site involvement, 74 patients (15%) received chemotherapy (44 as palliative chemotherapy and 30 as perioperative chemotherapy). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients), platinum (8 patients) and taxane (8 patients), and the dosage and timing of these drugs differed between institutions; however, the dosage of molecular targeted drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients receiving palliative chemotherapy was 13.0 months (0.1-60.3 months). Three patients (6.8%) died from treatment-related causes and nine patients (20%) died of causes other than cancer. Of the 30 patients who received perioperative chemotherapy, 6 (20%) died of causes other than cancer within 3 years after the initiation of chemotherapy.
CONCLUSIONS: Among the haemodialysis patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. Indications for the use of chemotherapy in patients undergoing haemodialysis should be considered carefully.
METHODS: The nationwide survey included patients undergoing haemodialysis who were subsequently diagnosed with cancer in 20 hospitals in Japan from January 2010 to December 2012. We reviewed their clinical data, including cancer at the following primary sites: kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast. The questionnaires consisted of the following subjects: (1) patient characteristics; (2) regimen, dosage and timing of chemotherapy; and (3) clinical outcome.
RESULTS: Overall, 675 patients were registered and assessed for main primary cancer site involvement. Of 507 patients with primary site involvement, 74 patients (15%) received chemotherapy (44 as palliative chemotherapy and 30 as perioperative chemotherapy). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients), platinum (8 patients) and taxane (8 patients), and the dosage and timing of these drugs differed between institutions; however, the dosage of molecular targeted drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients receiving palliative chemotherapy was 13.0 months (0.1-60.3 months). Three patients (6.8%) died from treatment-related causes and nine patients (20%) died of causes other than cancer. Of the 30 patients who received perioperative chemotherapy, 6 (20%) died of causes other than cancer within 3 years after the initiation of chemotherapy.
CONCLUSIONS: Among the haemodialysis patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. Indications for the use of chemotherapy in patients undergoing haemodialysis should be considered carefully.
摘要：
背景：癌症是血液透析患者死亡的主要原因。然而,缺乏关于接受血液透析的癌症患者化疗的实际临床实践的信息。我们使用问卷调查对此类患者的化疗临床实践进行了全国性调查。
方法：全国调查包括2010年1月至2012年12月在日本20家医院接受血液透析的患者，这些患者随后被诊断患有癌症。我们回顾了他们的临床资料,包括以下主要部位的癌症：肾脏，结肠直肠,胃,肺，肝脏,膀胱,胰腺和乳房。问卷包括以下主题：（1）患者特征；（2）治疗方案，化疗的剂量和时机；和（3）临床结果。
结果：总体而言，对675名患者进行了登记并评估了主要原发癌部位的受累情况。507例原发部位受累患者中，74例患者（15％）接受了化疗（44例作为姑息性化疗，30例作为围手术期化疗）。最常用的细胞毒性药物是氟嘧啶（15例），铂（8例）和紫杉烷（8例），这些药物的剂量和时间因机构而异；然而，分子靶向药物（24例）和激素治疗药物（15例）的剂量一致。接受姑息性化疗的患者的中位生存时间为13.0个月（0.1-60.3个月）。3名患者（6.8％）死于治疗相关原因，9名患者（20％）死于癌症以外的原因。在接受围手术期化疗的30例患者中，6人(20%)在化疗开始后3年内死于除癌症以外的其他原因。
结论：在接受化疗的癌症血液透析患者中，姑息化疗和围手术期化疗的癌症以外的原因导致的死亡率可能都很高.应仔细考虑在接受血液透析的患者中使用化学疗法的适应症。
方法：全国调查包括2010年1月至2012年12月在日本20家医院接受血液透析的患者，这些患者随后被诊断患有癌症。我们回顾了他们的临床资料,包括以下主要部位的癌症：肾脏，结肠直肠,胃,肺，肝脏,膀胱,胰腺和乳房。问卷包括以下主题：（1）患者特征；（2）治疗方案，化疗的剂量和时机；和（3）临床结果。
结果：总体而言，对675名患者进行了登记并评估了主要原发癌部位的受累情况。507例原发部位受累患者中，74例患者（15％）接受了化疗（44例作为姑息性化疗，30例作为围手术期化疗）。最常用的细胞毒性药物是氟嘧啶（15例），铂（8例）和紫杉烷（8例），这些药物的剂量和时间因机构而异；然而，分子靶向药物（24例）和激素治疗药物（15例）的剂量一致。接受姑息性化疗的患者的中位生存时间为13.0个月（0.1-60.3个月）。3名患者（6.8％）死于治疗相关原因，9名患者（20％）死于癌症以外的原因。在接受围手术期化疗的30例患者中，6人(20%)在化疗开始后3年内死于除癌症以外的其他原因。
结论：在接受化疗的癌症血液透析患者中，姑息化疗和围手术期化疗的癌症以外的原因导致的死亡率可能都很高.应仔细考虑在接受血液透析的患者中使用化学疗法的适应症。
