Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, CHRU Tours, Francois Rabelais University, Tours, France.
Curr Opin Urol. 2020 May;30(3):467-474. doi: 10.1097/MOU.0000000000000749.
The aim of this article is to review incidence, risk factors, and optimal management of de-novo urothelial carcinoma in transplant recipients.
There is a two to three-fold increased risk for de-novo malignant tumors after solid-organ transplantation, but there is currently no consensus regarding optimal management of de-novo urothelial carcinoma in transplanted patients. Known risk factors include polyomavirus BK, aristolochic acid, and smoking. Data suggest a higher rate of high-grade tumors, as well as predominantly higher stage at primary diagnosis, for both NMIBC and muscle-invasive bladder cancer (MIBC). Treatment for NMIBC includes TURB, mitomycin, and Bacille de Calmette-Guérin instillation with special concern to the immunosuppressive regime. Treatment of MIBC or advanced urothelial carcinoma includes radical cystectomy with chemotherapy if the patient is eligible. A screening should be performed in all transplant recipients, to allow early diagnosis.
De-novo urothelial carcinoma in transplant recipients is more frequent than in the general population and these tumors were more likely to be high-grade tumors and diagnosed at an advanced stage. There is very little information available on the optimal treatment for these patients. However, aggressive treatment and a strict management according the given recommendations are of the utmost importance.
本文旨在回顾移植受者中新发尿路上皮癌的发病率、危险因素和最佳治疗方法。
实体器官移植后新发恶性肿瘤的风险增加了两到三倍，但目前对于移植患者新发尿路上皮癌的最佳治疗方法尚无共识。已知的危险因素包括 BK 多瘤病毒、马兜铃酸和吸烟。数据表明，非肌层浸润性膀胱癌（NMIBC）和肌层浸润性膀胱癌（MIBC）患者的高级别肿瘤发生率以及初诊时的主要分期更高。NMIBC 的治疗包括 TURB、丝裂霉素和卡介苗灌注，特别需要注意免疫抑制方案。MIBC 或晚期尿路上皮癌的治疗包括如果患者符合条件则进行根治性膀胱切除术和化疗。所有移植受者均应进行筛查，以便早期诊断。
移植受者中新发的尿路上皮癌比普通人群更为常见，这些肿瘤更有可能是高级别肿瘤，且在晚期被诊断出。关于这些患者的最佳治疗方法几乎没有信息。然而，积极的治疗和根据建议进行严格的管理至关重要。
