ArticleBMC cancer2026
Prognostic outcomes of adjuvant chemotherapy in postoperative patients with cancer undergoing hemodialysis versus non-hemodialysis patients: a retrospective nationwide cohort study.
Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSurvival outcomes for patients with cancer undergoing hemodialysis (HD) are poorer than those for patients not undergoing HD, possibly owing to altered chemotherapy protocols or undertreatment to address renal impairment and drug toxicity concerns. Adjuvant chemotherapy should be administered appropriately with evidence-based drug selection. However, in patients undergoing HD, the administration of adjuvant chemotherapy and its association with prognosis remain unclear. We evaluated the association between adjuvant chemotherapy and survival outcomes in patients undergoing HD compared with those not undergoing HD in Japan.
methodsA nationwide dataset combining Hospital-Based Cancer Registry and Diagnosis Procedure Combination survey data was utilized. The study included adult patients newly diagnosed with colorectal, gastric, breast, or non-small cell lung cancer between January 2013 and December 2015. The primary survival analysis used a 90-day landmark approach: patients who were alive at postoperative day 90 and had survival follow-up information available thereafter were included, adjuvant chemotherapy was defined as treatment initiated within 90 days after surgery, and overall survival was measured from postoperative day 90 to death or last confirmed survival. Multivariable Cox regression models included hemodialysis status, adjuvant chemotherapy, their interaction term, age, sex, cancer type, Barthel Index, comorbidities, and hospital type.
resultsIn the final cohort, 44,281 patients met the eligibility criteria. Among 43,984 patients included in the primary 90-day landmark analysis, 451 were undergoing HD. Patients undergoing HD were less likely to initiate adjuvant chemotherapy within 90 days after surgery than those not undergoing HD (30.4% vs. 68.0%, P < 0.001). In the multivariable Cox model with an interaction term, HD was associated with worse overall survival among patients who did not initiate adjuvant chemotherapy within 90 days after surgery (adjusted hazard ratio [aHR], 1.91; 95% confidence interval [CI], 1.67-2.18; P < 0.001), and the HD × adjuvant chemotherapy interaction was statistically significant (P = 0.002). The association between adjuvant chemotherapy and overall survival was evident among patients not undergoing HD but was not statistically significant among patients undergoing HD. In an exploratory analysis restricted to patients undergoing HD who initiated adjuvant chemotherapy, use of a standard regimen was associated with better survival than use of a non-standard regimen.
conclusionsPatients undergoing HD were less likely to receive adjuvant chemotherapy and had worse overall survival. The association between adjuvant chemotherapy and survival appeared attenuated among patients undergoing HD. Further prospective studies are needed to define optimal postoperative chemotherapy strategies for this population.
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