Department of Urology, Félix Guyon University Hospital, Saint-Denis de la Réunion, France.
BJU Int. 2012 Dec;110(11 Pt B):E570-3. doi: 10.1111/j.1464-410X.2012.11273.x. Epub 2012 Jun 22.
What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3-4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process.
• To compare clinical, pathological and outcome features of renal cell carcinomas (RCCs) arising in patients with chronic renal failure (CRF) with or without renal transplantation.
• In all, 24 French University Departments of Urology and Kidney Transplantation participated in this retrospective study comparing RCCs arising in patients with CRF according to their dialysis or transplantation status at the time of diagnosis. • Information about age, sex, symptoms, duration of CRF, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. • Qualitative and quantitative variables were compared by using chi-square and Student statistical analysis. Survival was assessed by Kaplan-Meier and Cox methods.
• Data on 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). • Transplanted and not transplanted patients accounted for 213 (70.3%) and 90 cases (29.7%), respectively. • In transplant recipients, RCC was diagnosed at a younger age [mean (sd) 53 (11) vs 61 (14) years, P < 0.001), the mean tumour size was smaller [3.4 (2.3) vs 4.2 (3.1) cm, P= 0.02), pT1a stage (75 vs 60%, P= 0.009) and papillary histological subtype (44 vs 22%, P < 0.001) were more frequent than in their dialysis-only counterparts. • Nodal (1 vs 6%, P= 0.03) and distant metastases rates (0 vs 5%, P < 0.001) were significantly increased in patients who had not had a transplant. However, Fürhman grading, symptoms, tumour multifocality or bilaterality, presence of acquired cystic kidney disease, were not significantly different between the groups. • Estimated 5-year survival rates were 97% and 77% for transplanted and not transplanted patients, respectively (P < 0.001). In univariate analysis, presence of symptoms (P= 0.008), poor performance status (P= 0.04), large tumour size, advanced TNM stage (P < 0.001), high Führman grade (P= 0.005) and absence of transplantation (P < 0.001) were all adverse prognostic factors. In multivariate analysis, only T stage remained an independent predictor for cancer-related death (P < 0.001).
• RCC arising in native kidneys of transplant patients seems to exhibit many favourable clinical, pathological and outcome features compared with those diagnosed in dialysis-only patients. Further research is needed to determine whether it is due to particular molecular pathways or to biases in relation to mode of diagnosis.
患有终末期肾病（ESRD）的患者在其原肾中发展为 RCC 的风险增加。在透析和/或移植患者中，ESRD 患者的 RCC 患病率为 3-4%，这一比率比普通人群高 100 倍。据我们所知，这是第一项比较根据诊断时透析或移植状态，在 ESRD 人群中肾细胞癌（RCC）的特征的研究。我们观察到的分期和生存差异可能是由于移植和未移植患者之间的监测策略不同所致，但病理亚型的差异表明，它们也可能是由于肿瘤发生过程的不同。
比较慢性肾功能衰竭（CRF）患者伴或不伴肾移植时发生的肾细胞癌（RCC）的临床、病理和结局特征。
共有 24 个法国大学泌尿科和肾移植科参与了这项回顾性研究，比较了根据诊断时透析或移植状态，在 CRF 患者中发生的 RCC。记录了年龄、性别、症状、CRF 持续时间、透析方式和持续时间、肾移植、肿瘤分期和分级、组织学亚型和结局等信息在一个独特的数据库中。使用卡方和学生统计分析比较定性和定量变量。通过 Kaplan-Meier 和 Cox 方法评估生存情况。
在 1985 年至 2009 年期间诊断的 303 例 RCC 病例中，有 206 名男性（76.3%）和 64 名女性（23.7%）。移植和未移植患者分别占 213 例（70.3%）和 90 例（29.7%）。在移植受者中，RCC 的诊断年龄较小[平均（标准差）53（11）比 61（14）岁，P<0.001），肿瘤平均大小较小[3.4（2.3）比 4.2（3.1）cm，P=0.02]，pT1a 期（75 比 60%，P=0.009）和乳头状组织学亚型（44 比 22%，P<0.001）比仅透析的患者更常见。淋巴结（1 比 6%，P=0.03）和远处转移率（0 比 5%，P<0.001）在未接受移植的患者中显著增加。然而，Fürhman 分级、症状、肿瘤多灶性或双侧性、获得性囊性肾病的存在在两组之间没有显著差异。移植和未移植患者的估计 5 年生存率分别为 97%和 77%（P<0.001）。单因素分析显示，有症状（P=0.008）、表现状态差（P=0.04）、肿瘤体积大、TNM 分期晚期（P<0.001）、Führman 分级高（P=0.005）和未接受移植（P<0.001）是所有不良预后因素。多因素分析显示，只有 T 分期仍然是癌症相关死亡的独立预测因素（P<0.001）。
与仅透析患者诊断的 RCC 相比，移植患者原肾中发生的 RCC 似乎具有许多有利的临床、病理和结局特征。需要进一步研究以确定这是否是由于特定的分子途径或与诊断方式有关的偏差所致。
