Schmidt Jacob, Yakac Abdulbaki, Peters Robert, Friedersdorff Frank, Kernig Karoline, Kienel Anna, Winterhagen Franziska I, Köpp Friedrich, Foller Susan, DiQuilio Francesca, Weigand Karl, Flegar Luka, Reimold Philipp, Stöckle Michael, Putz Juliane, Zeuschner Philip
Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany.
Eur Urol Open Sci. 2024 Jul 29;67:45-53. doi: 10.1016/j.euros.2024.07.111. eCollection 2024 Sep.
Kidney transplant recipients (KTRs) have an increased risk of developing genitourinary cancers, including prostate cancer (PCa), which is expected to become more prevalent due to an aging KTR population. Thus, knowledge of surgical outcomes, including treatment of PCa, within this unique cohort is required.
Data of 62 KTRs undergoing radical prostatectomy (RP) between 2006 and 2023 at nine urologic transplant centers were analyzed. Complications were assessed using the Clavien-Dindo classification. Perioperative outcomes were evaluated, and a follow-up was conducted. Overall survival (OS), biochemical recurrence-free survival (BRFS), and death-censored graft survival were determined via the Kaplan-Meier method and log-rank testing.
Overall, 50 open radical retropubic RPs and 12 robot-assisted RPs (RARPs) were included. The intraoperative blood loss was lower after RARP, but operative time was longer. Of the patients, 50% experienced no postoperative complication, and grade ≥3 complications were observed in 14.5%. There was no graft loss related to RP. A histopathologic analysis revealed pN1 in 8.1% and positive surgical margins in 25.8% of the cases. At a median follow-up of 48.5 mo, the median OS was 128 (95% confidence interval [CI] 71.2-184.8) mo, BRFS was 106 (95% CI 55.8; 156.2) mo, and graft survival was 127 (95% CI 66.7-187.3) mo. Limitations include the retrospective design, and variations between groups and centers.
Our findings support RP as a feasible and safe treatment option for localized PCa in KTRs with acceptable oncologic outcome. Special care is required in screening and awareness for the risk of understaging.
This study analyzed the safety and effectiveness of two prostate cancer surgery methods-open and robot-assisted surgery-in the special group of kidney transplant recipients. Both surgical methods were performed safely with acceptable oncologic outcomes; however, sample size was too small to draw definite conclusions between the two operative methods.
肾移植受者（KTRs）发生泌尿生殖系统癌症的风险增加，包括前列腺癌（PCa），由于KTR人群老龄化，预计其发病率将更高。因此，需要了解这一特殊队列中的手术结果，包括PCa的治疗情况。
分析了2006年至2023年期间在9个泌尿外科移植中心接受根治性前列腺切除术（RP）的62例KTRs的数据。使用Clavien-Dindo分类法评估并发症。评估围手术期结果并进行随访。通过Kaplan-Meier方法和对数秩检验确定总生存期（OS）、无生化复发生存期（BRFS）和死亡截尾移植生存期。
总体而言，包括50例开放性耻骨后根治性前列腺切除术和12例机器人辅助根治性前列腺切除术（RARPs）。RARP术后术中失血量较低，但手术时间较长。50%的患者无术后并发症，14.5%的患者出现≥3级并发症。没有与RP相关的移植丢失。组织病理学分析显示，8.1%的病例有pN1，25.8%的病例手术切缘阳性。中位随访48.5个月时，中位OS为128（95%置信区间[CI]71.2-184.8）个月，BRFS为106（95%CI55.8；156.2）个月，移植生存期为127（95%CI66.7-187.3）个月。局限性包括回顾性设计以及组间和中心间的差异。
我们的研究结果支持RP作为KTRs局限性PCa的一种可行且安全的治疗选择，其肿瘤学结果可接受。在筛查和认识分期不足风险方面需要特别注意。
本研究分析了肾移植受者这一特殊群体中两种前列腺癌手术方法——开放手术和机器人辅助手术——的安全性和有效性。两种手术方法均安全进行，肿瘤学结果可接受；然而，样本量太小，无法在两种手术方法之间得出明确结论。
