Ryosaka Makoto, Ishida Hideki, Takagi Toshio, Shimizu Tomokazu, Tanabe Kazunari, Kondo Tsunenori
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Transpl Int. 2015 Jul;28(7):813-9. doi: 10.1111/tri.12571.
Incidental hemodialysis-related renal cell carcinoma (id-RCC) has been reported to have a good prognosis. However, we have observed rapid progression of id-RCC in some renal transplant patients. Operative indications for id-RCC detected via computed tomography (CT) immediately before renal transplantation (RTx) remain unclear. The purpose of this study was to examine the effects of immunosuppression on the progression of solid-type RCC (s-RCC) and cystic-type RCC (c-RCC). We divided 202 patients with id-RCC into four groups as follows: Group 1, s-RCC with RTx (n = 17); Group 2, c-RCC with RTx (n = 27); Group 3, s-RCC without RTx (n = 53); and Group 4, c-RCC without RTx (n = 105). Five-year cancer specific survival (CSS) rates were significantly worse in Group 1 than Group 3 (79.6% and 100%, respectively, P = 0.012), as were non-recurrence rates (NRRs) (59.2 and 100%, respectively, P < 0.001). In contrast, 5-year CSS rates were similar in Group 2 and Group 4 (100% and 95.7%, respectively, P = 0.295) as were NRR (100% and 98.7%, respectively, P = 0.230). Solid-type RCC should be removed immediately after RTx, and more carefully monitored for recurrence during follow-up.
据报道，偶发性血液透析相关肾细胞癌（id-RCC）预后良好。然而，我们观察到部分肾移植患者的id-RCC进展迅速。肾移植（RTx）前通过计算机断层扫描（CT）检测到的id-RCC的手术指征仍不明确。本研究的目的是探讨免疫抑制对实性型肾细胞癌（s-RCC）和囊性型肾细胞癌（c-RCC）进展的影响。我们将202例id-RCC患者分为以下四组：第1组，接受RTx的s-RCC（n = 17）；第2组，接受RTx的c-RCC（n = 27）；第3组，未接受RTx的s-RCC（n = 53）；第4组，未接受RTx的c-RCC（n = 105）。第1组的5年癌症特异性生存率（CSS）显著低于第3组（分别为79.6%和100%，P = 0.012），无复发生存率（NRR）也是如此（分别为59.2%和100%，P < 0.001）。相比之下，第2组和第4组的5年CSS率相似（分别为100%和95.7%，P = 0.295），NRR也是如此（分别为100%和98.7%，P = 0.230）。实性型RCC应在RTx后立即切除，并在随访期间更密切地监测复发情况。
