Urothelial carcinoma in Chinese dialysis patients: a 20-year single-center retrospective cohort study of pre- and post-dialysis development

Urothelial carcinoma (UC) presents with a uniquely high incidence and distinct clinical profile among Chinese dialysis patients. While their overall elevated cancer risk is well-documented, how the timing of UC development relative to dialysis initiation impacts clinical behavior and long-term survival remains poorly understood. This gap hinders the optimization of targeted surveillance strategies. This study compared the clinical characteristics and survival outcomes of patients with UC before dialysis (Pre- and Post-Dialysis UC) to those developing UC exclusively after dialysis (Post-Dialysis Only UC). This retrospective study analyzed data from 100 patients who underwent dialysis for chronic kidney disease (CKD) and subsequently had UC surgery at a national center in Beijing, China, between 2000 and 2021. Patient demographics, clinical characteristics, and oncological outcomes were collected. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were analyzed using Kaplan–Meier methods and log-rank tests. Cox regression identified factors associated with survival. Of the 100 patients, 37 had Pre- and Post-Dialysis UC and 63 had Post-Dialysis Only UC. The Post-Dialysis Only UC group had significantly worse OS (log-rank p = 0.0207) and a trend toward poorer CSS (log-rank p = 0.1011). This group also had a higher proportion of females (74.60% vs 56.76% in Pre- and Post-Dialysis UC) and advanced-stage recurrences. Anuria was associated with worse RFS ( p = 0.045, log-rank p = 0.033). Age and alcohol history were independent risk factors for mortality in the Post-Dialysis Only UC group. Chinese dialysis patients who develop UC after dialysis initiation have distinct characteristics and poorer survival outcomes. Enhanced surveillance and tailored management are crucial for this vulnerable group.