Association of hepatitis C infection and risk of kidney cancer: A systematic review and meta-analysis of observational studies.

Although some epidemiological studies have investigated the association between Hepatitis C virus (HCV) infection and the development of kidney cancer, the results are far from consistent. We conducted a systematic review and meta-analysis of observational studies to determine the association. PubMed, EMBASE and Cochrane database were searched from 1 January 1975 to 7 January 2020. Study selection, data extraction and bias assessment (using the Newcastle-Ottawa scale) were performed independently by 2 authors. Pooled odds ratios (ORs) with corresponding confidence intervals (CIs) were calculated using a random-effects model. In all, 16 studies (11 cohort studies and 5 case-control studies) involving a total of 391,071 HCV patients and 38,333,839 non-HCV controls were included. The overall analysis showed a 47% higher risk to develop kidney cancer among the patients with HCV infection (pooled OR 1.47; 95% CI 1.14-1.91), despite significant heterogeneity (I2  = 87.6%). The multivariable meta-regression showed that study design, age, sample size and HIV co-infection were significant sources of variance, and totally accounted for 82% of the I2 . The risk of KC in HCV patients was further increased in studies without HCV/HBV- and HCV/HIV- co-infection (pooled OR 1.66; 95%CI 1.23-2.24). Multiple sensitivity analyses did not change the significant association. The present meta-analysis indicated that HCV-infected patients have a significantly higher risk of developing kidney cancer. Our results highlighted the rationale for improved renal surveillance in HCV patients for the early diagnosis of kidney cancer. Further investigations for the mechanisms underlying HCV-induced kidney cancer are warranted.

Effects of ultrasound-guided percutaneous transluminal angioplasty for stenosis of arteriovenous fistula used for hemodialysis and related factors influencing patency.

AIM: To evaluate the effects of ultrasound-guided percutaneous transluminal angioplasty (PTA) on the arteriovenous fistula (AVF) stenosis of hemodialysis graft. MATERIALS AND METHODS: A total of 189 patients with AVF dysfunction who underwent ultrasound-guided PTA were enrolled. Their baseline data were collected. The Log-rank test, Kaplan-Meier survival analysis and univariate Cox proportional risk regression analysis were performed to compare the primary and secondary patency rates and to explore the related influencing factors. RESULTS: A total of 256 sites of stenosis were found by ultrasonography, including 80 sites in anastomotic segment, 28 in supply artery segment, 60 in drainage vein segment and 88 in proximal segment of the internal fistula vein. The mean length of stenosis was 22.4 mm, and the mean degree was 93.4%. The success rate of surgery was 96.09%, with the postoperative residual stenosis of >30% in 3.91% of patients. The clinical success rate was 97.66% and complications occurred in 2.34% of patients. The mean follow-up time was 30.2 months, and vascular patency was observed in 25.93% of patients. The primary patency rates in 1st, 2nd and 3rd years after surgery were 84.66%, 60.85% and 21.69%, respectively, and the patients with diabetes (P=0.002) and old age (P<0.001) had lower rates. The secondary patency rates in 1st, 2nd and 3rd years after surgery were 91.00%, 74.07% and 32.80%, respectively, and a lower secondary patency rate was significantly correlated with diabetes (P=0.019), old age (P<0.001), long stenosis segment (P<0.001) and high degree of residual stenosis (P=0.012). CONCLUSIONS: Vascular patency can be maintained in hemodialysis patients with AVF dysfunction through repeated intervention, and there is no need to shorten the venous segment by surgery. Ultrasound-guided PTA is a promising substitute for traditional surgery. KEY WORDS: Arteriovenous Fistula, Hemodialysis, Ultrasound, Percutaneous Transluminal Angioplasty.

Therapeutic effects and associated adverse events of multikinase inhibitors in metastatic renal cell carcinoma: A meta-analysis.

This study aimed to compare the therapeutic effects and adverse events of the multikinase inhibitors sorafenib, sunitinib, pazopanib and axitinib in advanced renal cell carcinoma (RCC). A meta-analysis of randomized controlled trials was performed to assess the effects of multikinase inhibitors among patients with advanced RCC. The data of median progression-free survival (PFS), median overall survival (OS), progressive disease rate (PDR), objective response rate (ORR) and grade 3/4 adverse events were extracted to assess therapeutic effects and toxicity, respectively. It was found that multikinase inhibitors are more effective in extending PFS [hazard ratio (HR)=0.58; 95% confidence interval (CI): 0.45-0.74; P<0.0001), controlling tumor progression [relative risk (RR)=0.67; 95% CI: 0.55-0.83; P=0.0002) and ORR (RR=2.93; 95% CI: 1.40-6.14; P=0.004) compared with placebo or interferon-α. Patients treated with multikinase inhibitors had significantly higher rates of grade 3 or 4 hypertension (RR=6.00; 95% CI: 3.36-10.69; P<0.00001), diarrhea (RR=5.84; 95% CI: 3.06-11.16; P<0.00001), nausea (RR=2.30; 95% CI: 1.16-4.54; P=0.02), vomiting (RR=1.84; 95% CI: 1.00-3.41; P=0.05) and hand-foot skin reaction (RR=11.78; 95% CI: 5.16-26.93; P<0.00001). Multikinase inhibitors can significantly control disease progress and improve the ORR. However, they are also associated with a higher risk of grade 3 and 4 hypertension and gastrointestinal events. Proper management of these events is necessary to improve patient quality of life.