TY - JOUR
T1 - Cutaneous Squamous Cell Carcinoma and Mortality in End-Stage Renal Disease
AU - Jung, Joo
AU - Waller, Jennifer L
AU - Tran, Sarah
AU - Baer, Stephanie L.
AU - Kheda, Mufaddal
AU - Mohammed, Azeem Abdul
AU - Padala, Sandeep Anand
AU - Young, Lufei
AU - Siddiqui, Budder
AU - Bollag, Wendy B.
N1 - Funding Information:
This work was supported in part by the Medical Scholars Program of the Medical College of Georgia (JJ) and the Translational Research Program of the Department of Medicine, a grant from Dialysis Clinic, Inc. (JLW, MFK, AM), and the Charlie Norwood VAMC (WBB, SLB). The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government. The data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the United States Government.
Publisher Copyright:
© 2022
PY - 2022/11/17
Y1 - 2022/11/17
N2 - BACKGROUND: In the general population, cutaneous squamous cell carcinoma (cSCC) is associated with increased all-cause mortality. Transplant patients have been shown to have an increased risk of developing cSCC, and their cSCC is associated with an increased risk for mortality. In end-stage renal disease (ESRD) patients, there is extensive mortality and immune dysfunction. Because of this immune system dysfunction, we examined whether cSCC is associated with increased risk of all-cause mortality among ESRD patients, as well as the risk factors for cSCC.METHODS: We analyzed ESRD patients in the United States Renal Data System from 2004-2014, excluding organ transplant recipients. We assessed mortality using a Cox Proportional Hazards (CPH) model to control for various demographic and clinical parameters, identified using international classification of diseases (ICD)-9 codes.RESULTS: Of the 1,035,193 patients included, 624 (0.1%) were diagnosed with cSCC. The median survival time for those with cSCC was 3.91 years [95% confidence interval (CI)=3.67-4.15], versus 2.92 years [95%CI=2.92-2.93] for patients without cSCC. ESRD patients with cSCC were at lower risk of death [adjusted hazard ratio=0.75; 95%CI=0.69-0.82] compared to those without. Decreased risk of death was also associated with parameters such as black race, Hispanic ethnicity, tobacco dependence and actinic keratosis. Increased mortality risk was associated with increasing age, male sex, hemodialysis (versus peritoneal dialysis) and alcohol dependence.CONCLUSIONS: Contrary to expectations, ESRD patients with a cSCC diagnosis showed reduced all-cause mortality risk relative to those without. The reason for this discrepancy remains unclear, suggesting the need for further study.
AB - BACKGROUND: In the general population, cutaneous squamous cell carcinoma (cSCC) is associated with increased all-cause mortality. Transplant patients have been shown to have an increased risk of developing cSCC, and their cSCC is associated with an increased risk for mortality. In end-stage renal disease (ESRD) patients, there is extensive mortality and immune dysfunction. Because of this immune system dysfunction, we examined whether cSCC is associated with increased risk of all-cause mortality among ESRD patients, as well as the risk factors for cSCC.METHODS: We analyzed ESRD patients in the United States Renal Data System from 2004-2014, excluding organ transplant recipients. We assessed mortality using a Cox Proportional Hazards (CPH) model to control for various demographic and clinical parameters, identified using international classification of diseases (ICD)-9 codes.RESULTS: Of the 1,035,193 patients included, 624 (0.1%) were diagnosed with cSCC. The median survival time for those with cSCC was 3.91 years [95% confidence interval (CI)=3.67-4.15], versus 2.92 years [95%CI=2.92-2.93] for patients without cSCC. ESRD patients with cSCC were at lower risk of death [adjusted hazard ratio=0.75; 95%CI=0.69-0.82] compared to those without. Decreased risk of death was also associated with parameters such as black race, Hispanic ethnicity, tobacco dependence and actinic keratosis. Increased mortality risk was associated with increasing age, male sex, hemodialysis (versus peritoneal dialysis) and alcohol dependence.CONCLUSIONS: Contrary to expectations, ESRD patients with a cSCC diagnosis showed reduced all-cause mortality risk relative to those without. The reason for this discrepancy remains unclear, suggesting the need for further study.
KW - End-stage renal disease
KW - Mortality
KW - Skin cancer
KW - Squamous cell carcinoma
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U2 - 10.1016/j.amjms.2022.10.002
DO - 10.1016/j.amjms.2022.10.002
M3 - Article
C2 - 36403674
SN - 0002-9629
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
ER -