洗腎與腎臟移植病患罹患上泌尿道泌尿上皮癌有何異同?

蔡仕傑¹、黃逸修^1,2、黃子豪^1,2、魏子鈞^1,2、林志杰^1,2、

林子平^1,2、鍾孝仁^1,2、張延驊^1,2、黃志賢^{1, 2}

¹臺北榮民總醫院泌尿部；²國立陽明交通大學醫學系泌尿學科及書田泌尿科學研究中心

Is the native upper urinary tract urothelial carcinoma different between dialysis patients and renal transplant recipients?

Shi-Jie Tsai¹, Eric Yi-Hsiu Huang ^{1, 2}, Tzu-Hao Huang^{1, 2}, Tzu-Chun Wei^{1, 2}, Chih-Chieh Lin^{1, 2},

Tzu-Ping Lin^{1, 2}, Hsiao-Jen Chung^{1, 2}, Yen-Hwa Chang^{1, 2}, William J.S. Huang^{1, 2}

¹ Department of Urology, Taipei Veterans General Hospital,

²Department of Urology, College of Medicine and Shu-Tien Urological Science Research Center,

National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Dialysis and kidney transplant are both treatment options for end-stage renal disease (ESRD). In Taiwan, it is well known that ESRD patients receiving dialysis are associated with increased risk of urothelial carcinoma, especially upper tract urothelial carcinoma (UTUC). Meanwhile, kidney transplant recipients were associated with increased incidence of malignancy due to use of immunosuppressant. Therefore, we aim to compare clinical characteristics and oncological outcomes between dialysis and transplant patients with native UTUC underwent radical nephroureterectomy (RNU).

Materials and Methods:

We retrospectively reviewed patients with a history of ESRD who underwent dialysis or kidney transplant received RNU for native UTUC at Taipei Veterans General Hospital from 2005 to 2021. The demographic data, histopathological features, and oncologic outcomes were analyzed. We compared the clinical characteristics and oncological outcomes of dialysis and kidney transplant patients with native UTUC who underwent radical nephroureterectomy (RNU) using the Chi-square and Kaplan-Meier methods."

Results:

In total, 60 dialysis patients and 26 kidney transplant patients were identified with native UTUC. The mean age of patients at the time of RNU was 65.4±12.5 years (range 22-89). Among kidney transplant patients, UTUC was diagnosed an average of 10.36±5.5 years (range 1.5-19) after the transplant. For dialysis patients, the time interval between their first dialysis treatment and the RNU surgery was 5.09±4.8 years (range 0.2-15).

The histopathological results of RNU showed similar proportion of locally advanced tumors (pT3/4 or node positive) between dialysis (36%) and kidney transplant patients (42%). However, a higher incidence of multifocal tumors was identified in kidney transplant patients (55%) compared to dialysis patients (45%, p=0.002). Additionally, the presence of concomitant carcinoma in situ (CIS) was significantly higher in transplant patients (50%) than dialysis patients (20%, p=0.003).

The median follow-up period of our cohort was 44 months (range 2-212). We found no difference in overall survival rates between dialysis patients (67%) and kidney transplant patients (62%) (p=0.508), and cancer-specific survival rates were also similar between the two groups (83% and 77%, respectively, p=0.232). However, we did observe a higher incidence of bladder recurrences in kidney transplant patients (54%) compared to dialysis patients (35%, p=0.034), with a median interval of 8.5 months from RNU to recurrences.

Conclusions:

Kidney transplant patients with native UTUC had a higher incidence of concomitant CIS compared to dialysis patients. The long-term survival was similar between two groups, but kidney transplant patients had higher bladder recurrence rate.