University of Minnesota, Department of Urology, Minneapolis, MN; Minneapolis Veterans Affairs Medical Center, Department of Urology, Minneapolis, MN.
University of Minnesota, Department of Urology, Minneapolis, MN.
Urology. 2020 Nov;145:152-158. doi: 10.1016/j.urology.2020.06.077. Epub 2020 Aug 5.
To better understand the risk of genitourinary malignancies in the renal transplant patient. Currently, no consensus exists regarding screening and intervention, with much of the clinical decision-making based on historical practices established before recent progress in immunosuppression protocols and in genitourinary cancer diagnosis and management.
A database of all solid organ transplants performed at the University of Minnesota from 1984 to 2019 was queried for renal transplant recipients in whom development of subsequent urologic malignancies (prostate, bladder, renal, penile, and testicular cancer) was found.
Among 6172 renal transplant recipients examined, cumulative incidence of all cancers of genitourinary etiology are presented over an average follow-up time of 10 years. Kidney cancer (combined graft and native), prostate cancer, and bladder cancer each demonstrated respective 30-year incidence of 4.6%, 8.7%, and 1.5% from the time of transplant. By comparison, age-matched data from the Surveillance, Epidemiology, and End Results database demonstrated 30-year cumulative incidence of 1.1%, 11.1%, and 1.7% for kidney cancer, prostate cancer, and bladder cancer respectively. The predominant genitourinary cancer was renal cell cancer, both of the native and of the transplanted kidney (native, n = 64; transplanted, n =11), followed by prostate cancer (n = 63), and bladder cancer (n = 37).
In this closely followed cohort of renal transplant recipients, renal cancer occurs at a higher incidence rate than in the non-transplanted population, while a lower rate of prostate cancer was found, with bladder cancer demonstrating a comparable cumulative incidence between transplant patients and the national age-matched population.
更好地了解肾移植患者发生泌尿生殖系统恶性肿瘤的风险。目前，对于筛查和干预措施尚未达成共识，大部分临床决策都是基于免疫抑制方案以及泌尿生殖系统癌症诊断和管理方面的最新进展之前制定的历史实践。
检索了 1984 年至 2019 年在明尼苏达大学进行的所有实体器官移植患者的数据库，以寻找随后发生泌尿系统恶性肿瘤（前列腺、膀胱、肾脏、阴茎和睾丸癌）的肾移植受者。
在检查的 6172 例肾移植受者中，呈现了平均随访 10 年的所有泌尿生殖系统病因癌症的累积发生率。肾移植后 30 年的肾肿瘤（包括移植物和供体肾）、前列腺癌和膀胱癌的发病率分别为 4.6%、8.7%和 1.5%。相比之下，来自监测、流行病学和最终结果数据库的年龄匹配数据显示，肾肿瘤、前列腺癌和膀胱癌的 30 年累积发病率分别为 1.1%、11.1%和 1.7%。泌尿生殖系统最常见的癌症是肾细胞癌，包括供体肾和移植肾（供体肾，n=64；移植肾，n=11），其次是前列腺癌（n=63）和膀胱癌（n=37）。
在本研究中，在密切随访的肾移植受者队列中，肾肿瘤的发病率高于非移植人群，而前列腺癌的发病率较低，膀胱癌的累积发病率在移植患者和全国年龄匹配人群之间相当。
