Transitional cell carcinoma in renal transplant recipients
Transitional cell carcinoma in renal transplant recipients
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DOI：
10.1007/s00268-003-6954-3
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发表时间：
2003-08-01
影响因子：
2.6
通讯作者：
Shu, KH
中科院分区：
文献类型：
--
作者：
Kao, YL;Ou, YC;Shu, KH
肾移植(RTX)受者的癌症发病率很高，包括移行细胞癌(TCC)。移植后的泌尿系恶性肿瘤仍然是移植外科医生面临的挑战。利用台中退伍军人总医院透析与移植登记处，在1983年5月至2001年9月期间，52名RTX接受者中，共有55人被诊断为癌症。在这些患者中，有24名RTX受者被确认患有TCC，并且在台湾，RTX后TCC的恶性比例非常高(43.6%)。从移植到首次诊断的平均时间为46个月。无痛性血尿伴脓尿是最常见的表现形式。RTX受者移行细胞癌呈多灶性。此外，9例(41%)受者双侧上尿路同时发生膀胱移行细胞癌。病理诊断为侵袭性(PTA：2，PT1：7，PT2：4，PT3：6，PT4：2，移植物转移1例，远处转移2例)。6例受者发生播散性转移，均于16个月内死亡。5例患者接受了辅助化疗，肾功能稳定。我们的结论是，RTX受者在台湾TCC的发病率显著增加，在RTX受者合并TCC的患者中，预防性双侧肾输尿管切除和膀胱袖带切除可以同时进行。
Renal transplantation (RTx) recipients have a high incidence of cancer, including transitional cell carcinoma (TCC). Posttransplantation urologic malignancies still present a challenge for transplant surgeons. Using the Dialysis and Transplant Registry of Taichung Veterans General Hospital, a total of 55 cancers were diagnosed in 52 RTx recipients between May 1983 and September 2001. Of these, 24 RTx recipients developing TCC were identified and presented the distinctly high percentage (43.6%) of TCC that were malignancies after RTx in Taiwan. The mean time between transplantation and initial diagnosis was 46 months in our series. Painless hematuria with pyuria is the most common mode of presentation. Transitional cell carcinoma of RTx recipients had multiple foci. Moreover, synchronous TCC in bilateral upper urinary tracts were confirmed in 9 (41%) recipients. The pathologic status of disease is invasive at diagnosis (pTa: 2, pT1: 7, pT2: 4, pT3: 6, pT4:2, graft metastasis: 1 and distant metastasis: 2). Disseminated metastasis occurred in 6 recipients, all of whom died of their disease within 16 months. Five recipients received adjuvant chemotherapy and retained stable renal function. We conclude that RTx recipients have a markedly increased incidence of TCC in Taiwan, and that prophylactic bilateral nephroureterectomy of native kidneys with bladder cuff excision can be performed simultaneously in RTx recipients with TCC.