Ederer Ines A, Lucca Ilaria, Hofbauer Sebastian L, Haidinger Michael, Haitel Andrea, Susani Martin, Shariat Shahrokh F, Klatte Tobias
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
World J Urol. 2015 Dec;33(12):2087-93. doi: 10.1007/s00345-015-1554-z. Epub 2015 Apr 10.
Patients following solid organ transplantation have an increased risk of developing de novo bladder tumors, but their biology is poorly characterized.
We studied 1743 patients who underwent a transurethral resection of a newly diagnosed bladder tumor at a single institution. The histopathology, treatment, recurrence-free survival and overall survival were evaluated and compared between transplant and non-transplant patients.
We identified 74 transplant patients who developed a de novo bladder tumor after a median post-transplantation interval of 62 months. The tumor was malignant in 29 patients (39 %). The most common benign lesion was nephrogenic adenoma (84 %), which neither coexisted with nor developed into malignant tumors during follow-up. Compared with non-transplant patients (n = 1669), transplant patients were significantly younger (median 55 vs 69 years, P < 0.001) and had a 9.0-fold higher odds of benign tumors (P < 0.001), while there were no differences in pathology among patients with urothelial carcinoma of the bladder (UCB). In a multivariable analysis for non-muscle-invasive UCB that was adjusted for the risk group, patients with a transplant had a 1.8-fold increased risk of recurrence (P = 0.048). Four of five transplant patients did not respond to Bacillus Calmette-Guérin instillations. There were no differences in overall survival after radical cystectomy (P = 0.87).
The majority of bladder tumors in transplant patients are benign, and they neither coexist with nor develop into malignant tumors. Transplant patients with non-muscle-invasive UCB show an increased risk of disease recurrence, while those treated with radical cystectomy have similar outcomes to patients without a transplant.
实体器官移植后的患者发生新发膀胱肿瘤的风险增加，但其生物学特性尚不清楚。
我们研究了在单一机构接受经尿道新诊断膀胱肿瘤切除术的1743例患者。对移植患者和非移植患者的组织病理学、治疗、无复发生存率和总生存率进行了评估和比较。
我们确定了74例移植患者，他们在移植后中位间隔62个月后发生了新发膀胱肿瘤。29例患者（39%）的肿瘤为恶性。最常见的良性病变是肾源性腺瘤（84%），在随访期间既不与恶性肿瘤共存也不发展为恶性肿瘤。与非移植患者（n = 1669）相比，移植患者明显更年轻（中位年龄55岁对69岁，P < 0.001），良性肿瘤的发生几率高9.0倍（P < 0.001），而膀胱尿路上皮癌（UCB）患者的病理情况没有差异。在对风险组进行调整的非肌层浸润性UCB多变量分析中，移植患者的复发风险增加了1.8倍（P = 0.048）。五分之四的移植患者对卡介苗灌注无反应。根治性膀胱切除术后的总生存率没有差异（P = 0.87）。
移植患者中的大多数膀胱肿瘤是良性的，它们既不与恶性肿瘤共存也不发展为恶性肿瘤。非肌层浸润性UCB的移植患者疾病复发风险增加，而接受根治性膀胱切除术的患者与未移植患者的结局相似。
