Schmidt Jacob, Lehnert Malte, Lichy Isabel, Plage Henning, Jeutner Jonathan, Kurz Lukas, Ralla Bernhard, Lerchbaumer Markus H, Schlomm Thorsten, Friedersdorff Frank, Maxeiner Andreas, Peters Robert
Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Department of Urology, 12203 Berlin, Germany.
Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Department of Radiology, 10117 Berlin, Germany.
Cancers (Basel). 2025 Jun 30;17(13):2200. doi: 10.3390/cancers17132200.
: Kidney transplantation is associated with an increased risk of renal cell carcinoma (RCC). This study aimed to evaluate the outcomes of de novo RCC in kidney transplant recipients (KTRs). : We retrospectively identified 50 de novo RCC cases among 4012 KTRs transplanted from 2005 to 2024. Data on patient characteristics and outcomes were collected. Propensity score matching (PSM) compared 34 localized RCC cases in KTRs with 34 non-transplant RCC cases. The statistical analyses used Kaplan-Meier estimates, the log-rank test, and the Cox regression. : The RCC incidence was 0.64 per 1000 person-years, with a standardized incidence ratio of 4.40 (95% CI: 3.33-5.80). In the KTR cohort, clear cell RCC was present in 42%, and papillary RCC was present in 42%. RCC developed predominantly in native kidneys (92%). UICC stage I was present in 74%. The treatment for the non-metastatic RCC was nephrectomy in the majority of cases (91%). For the metastatic RCC, 71% received a tyrosine kinase inhibitor (TKI). In the KTR cohort, the 3- and 5-year overall survival (OS) rates were 85% and 72%, respectively, with a median OS of 199 months; the synchronous metastasized (M1) patients had a median OS of 14 months. Rejection, age, advanced UICC stage, higher pT stage, clinical positive lymph nodes, M1, and higher grade were significantly associated with poor OS. The 5-year OS (96% vs. 84%, = 0.72) and MFS (92% vs. 93%, = 0.61) were comparable in the PSM cohort between the KTRs and the non-KTRs in the localized RCC. : KTRs have a higher risk of RCC and present at a localized stage with comparable OS rates to non-transplant RCC patients. Adverse tumor characteristics, including synchronous metastases, significantly affect the prognosis, highlighting the need for surveillance and individualized treatment, particularly for metastatic RCC.
肾移植与肾细胞癌（RCC）风险增加相关。本研究旨在评估肾移植受者（KTRs）中初发性RCC的预后。
我们回顾性地在2005年至2024年接受移植的4012例KTRs中确定了50例初发性RCC病例。收集了患者特征和预后的数据。倾向评分匹配（PSM）将KTRs中的34例局限性RCC病例与34例非移植性RCC病例进行了比较。统计分析采用Kaplan-Meier估计、对数秩检验和Cox回归。
RCC发病率为每1000人年0.64例，标准化发病率为4.40（95%CI：3.33 - 5.80）。在KTR队列中，透明细胞RCC占42%，乳头状RCC占42%。RCC主要发生在自体肾（92%）。国际抗癌联盟（UICC）I期占74%。大多数非转移性RCC病例（91%）的治疗方法是肾切除术。对于转移性RCC，71%接受了酪氨酸激酶抑制剂（TKI）治疗。在KTR队列中，3年和5年总生存率（OS）分别为85%和72%，中位OS为199个月；同时发生转移（M1）的患者中位OS为14个月。排斥反应、年龄、UICC晚期、较高的pT分期、临床阳性淋巴结、M1和较高分级与较差的OS显著相关。在PSM队列中，KTRs和局限性RCC中的非KTRs的5年OS（96%对84%，P = 0.72）和无复发生存率（MFS，92%对93%，P = 0.61）相当。
KTRs患RCC的风险更高，且多表现为局限性阶段，其OS率与非移植性RCC患者相当。包括同时发生转移在内的不良肿瘤特征显著影响预后，这突出了监测和个体化治疗的必要性，特别是对于转移性RCC。
