Susceptibility of Developing Renal and Lung Cancer in Polycystic Kidney Disease Patients: An Evidence in Reaching Consensus

Abstract

Objective. The association between Polycystic Kidney Disease (PKD) and susceptibility to developing oncogenicity states remains controversial, and no consensus has yet been reached. Large-scale studies on this association are also lacking. Therefore, we identified the risk of developing cancer in PKD patients. Methods. Patients diagnosed with PKD between 2000 and 2010 were enrolled in the National Health Insurance Research Database (NHIRD)-derived Longitudinal Health Insurance. Patients with antecedent cancer, end-stage renal disease, or those diagnosed with cancer within one year were excluded. Using a Standardized Incidence Ratio (SIR), we compared the patterns of cancer incidence in PKD patients and the general population. Results. The entire cohort was observed for 8,014 people, and a total of 1820 PKD patients were included, and after a median follow-up of 4.43 years, 82 patients developed cancer. Though the risk of overall cancers was comparable between PKD patients and the general population, the PKD patients exhibited a higher risk of kidney malignancy (SIR 3.72, 95% CI 1.60∼7.33). The female PKD patients were at a higher risk of lung and mediastinal cancer (SIR: 2.83, 95% CI 1.03∼6.16). The subgroup analysis revealed a significantly higher risk of kidney cancer in the patients aged <65 years (SIR 7.39, 95% CI 1.99∼18.93) than those elderly patients, especially in the females (SIR 9.81, 95%1.10∼35.41, $p<0.05$ ). The multivariate analysis showed significant risk factors for cancer among the PKD population, including 1-year age (HR 1.04; 95% CI 1.02–1.06; $p<0.001$ ), male gender (HR 1.85; 95% CI 1.14–3.00; $p=0.012$ ), and chronic liver disease (HR 2.03; 95% CI 1.31–3.13; $p<0.001$ ). Conclusion. PKD patients may be more susceptible to developing renal, lung, and mediastinal cancer than the control population, which might be attributed to PKD genetic instability.