Goujon A, Verhoest G, Sallusto F, Branchereau J, Boutin J-M, Bessede T, Terrier N, Karam G, Badet L, Bigot P, Bensalah K, Méjean A, Timsit M-O
Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France.
Prog Urol. 2021 Jan;31(1):18-23. doi: 10.1016/j.purol.2020.04.030.
To define guidelines for the management of renal cell carcinoma of the native kidney (NKRCC) in kidney transplant (KTx) recipients and renal cell carcinoma (RCC) in end-stage renal disease (ESRD) patients candidates for renal transplantation.
A review of the literature following a systematic approach (Medline) was conducted by the CTAFU to report renal cell carcinoma epidemiology, screening, diagnosis and management in KTx candidates and recipients. References were assessed according to a predefined process to propose recommendations with the corresponding levels of evidence.
ESRD patients are at higher risk of RCC with a standardized incidence ratio of approximately 4,5 as compared with general population. NKRCC tumors occur in 1 to 3 % of KTx recipients with a 10 to 15-fold increased risk as compared with general population, especially in patients with acquired multicystic kidney disease. Most authors suggest yearly monitoring of the native kidneys using ultrasound imaging. Radical nephrectomy (either open or laparoscopic approach) is the preferred treatment of NKRCC in KTx recipients and RCC in ESRD. Surveillance in a valid option in small or cystic renal masses. In the localized setting, change in immunosuppressive therapy is not recommended besides perioperative avoidance of mTOR inhibitor to limit morbidity. CTAFU does not recommend a mandatory waiting time after nephrectomy for RCC in ESRD patients candidates for renal tranplantation when tumor stage<T3 and low ISUP grade. Follow-up modalities should follow recommendations in general population.
The French recommendations should contribute to improve management of NKRCC in KTx recipients and RCC in ESRD candidates for KTx, integrating oncological objectives in the context of kidney transplantation.
制定肾移植（KTx）受者的原发性肾细胞癌（NKRCC）以及终末期肾病（ESRD）且有肾移植候选资格患者的肾细胞癌（RCC）的管理指南。
CTAFU通过系统方法（Medline）对文献进行综述，以报告KTx候选者和受者中肾细胞癌的流行病学、筛查、诊断和管理情况。根据预定义流程对参考文献进行评估，以提出具有相应证据水平的建议。
与普通人群相比，ESRD患者患RCC的风险更高，标准化发病率约为4.5。NKRCC肿瘤发生在1%至3%的KTx受者中，与普通人群相比风险增加了10至15倍，尤其是在患有获得性多囊肾病的患者中。大多数作者建议每年使用超声成像对原发性肾脏进行监测。根治性肾切除术（开放或腹腔镜手术）是KTx受者中NKRCC以及ESRD患者中RCC的首选治疗方法。对于小的或囊性肾肿块，监测是一种有效的选择。在局限性情况下，除了围手术期避免使用mTOR抑制剂以限制发病率外，不建议改变免疫抑制治疗。对于肿瘤分期<T3且ISUP分级低的ESRD肾移植候选患者，CTAFU不建议肾切除术后有强制等待时间。随访方式应遵循普通人群的建议。
法国的这些建议应有助于改善KTx受者中NKRCC以及KTx的ESRD候选患者中RCC的管理，在肾移植背景下整合肿瘤学目标。
