RENAL-CELL CARCINOMA IN PATIENTS WITH END-STAGE RENAL-DISEASE - A COMPARISON OF CLINICAL-SIGNIFICANCE IN PATIENTS RECEIVING HEMODIALYSIS AND THOSE WITH RENAL-TRANSPLANTS

Objectives. This review was undertaken to determine the clinical signi ficance of renal cell carcinoma in the populations undergoing renal tr ansplantation and those undergoing chronic dialysis. Methods. We revie wed all medical records of patients with renal cell carcinoma treated at our institutions over the last 10 years. From this review we identi fied 20 patients with end-stage renal disease and renal cell carcinoma . Patients' charts were reviewed to determine presenting features, tum or histologic type, and clinical outcome. Results. Seven patients had functioning renal transplants and 13 patients were on chronic maintena nce hemodialysis. Ninety-two percent of the dialysis group had no meta static disease and there were no deaths from renal cancer. In contrast , 53% of the transplant group did have metastatic disease and 2 patien ts died of renal cancer. Despite similar pathologic appearances of the tumors in these 2 groups, patients with renal cell carcinoma and rena l transplant presented with higher-stage disease and had less favorabl e clinical courses. Conclusions. Considering the morbidity of hemodial ysis as well as the other comorbidities of this patient population, th e clinical significance of renal cell carcinoma in patients undergoing chronic dialysis must be questioned. In contrast, renal cancer in the transplant population behaves aggressively and warrants careful atten tion both before and after renal transplantation.