-
摘要: 目的 探讨肾移植术后新发膀胱肿瘤患者的临床特点、诊治和预后。方法 回顾性研究1997年1月—2022年4月在北部战区总医院(沈阳军区总医院)接受肾移植术后随访的10例新发膀胱肿瘤患者的临床资料。收集并分析患者肾移植手术时年龄、原发病、既往病史、吸烟及饮酒史、肿瘤家族史、新发膀胱肿瘤诊治经过及预后等资料。结果 肾移植术后新发膀胱肿瘤发生率为0.7%(10/1 420)，男女比例为3∶7，肾移植手术时年龄39~63岁，中位年龄53岁。原发病中未经病理证实的肾小球肾炎5例，高血压肾病1例，高血压肾病合并高尿酸血症1例，不明原因3例。既往均无吸烟史、饮酒史、特殊家族史。从接受肾移植手术至确诊为膀胱肿瘤的时间为7~236个月，中位时间为139个月。患者确诊为膀胱肿瘤后均行经尿道膀胱肿瘤切除术，术后常规使用表柔比星膀胱灌注，后有4例膀胱肿瘤复发。术后病理提示高级别乳头状尿路上皮癌7例，低级别乳头状尿路上皮癌3例。10例患者膀胱肿瘤预后良好，无死亡。移植肾带功9例，失功1例。结论 国内肾移植术后新发膀胱肿瘤发病率及复发率较高，但经积极干预后可获得较好的预后。其起病症状较为隐匿，对于具有致病高危因素的患者应积极进行有效的预防，定期行膀胱镜检查。新发膀胱肿瘤后，可考虑将免疫抑制剂改为西罗莫司。在膀胱灌注时使用卡介苗可能是一种更好的选择，但仍需大量研究进行验证。Abstract: Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of patients with new bladder tumor after renal transplantation.Methods A retrospective study was conducted on the clinical data of 10 patients with new bladder tumor who received kidney transplantation in The Northern Theater Command General Hospital(Shenyang Military Command General Hospital) from January 1997 to April 2022. The age, primary disease, past medical history, smoking and drinking history, family tumor history of the patients at the time of kidney transplantation, diagnosis and treatment of new bladder tumor and prognosiswere analyzed.Results The incidence of new bladder tumor after renal transplantation was 0.7% (10/1 420). The ratio of male to female was 3∶7. The patients were 39 to 63 years old at the time of kidney transplantation, with a median age of 53 years. Among the primary diseases, there were 5 cases of glomerulonephritis, 1 case of hypertensive nephropathy, 1 case of hypertensive nephropathy complicated with hyperuricemia, and 3 cases of unknown cause. All patients had no history of smoking, drinking or special family history. The time from kidney transplantation to diagnosis of bladder tumor ranged from 7 to 236 months, with a median of 139 months. After the diagnosis of bladder tumor was confirmed, all patients underwent transurethral resection of bladder tumor. After receiving routine bladder infusion with epirubicin, 4 patients had bladder tumor recurrence. Postoperative pathology revealed 7 cases of high-grade papillary urothelial carcinoma and 3 cases of low-grade papillary urothelial carcinoma. Ten patients had a good prognosis for bladder tumors without death. There were 9 patients with renal graft success and 1 patient with renal graft failure.Conclusion The incidence and recurrence rate of new bladder tumors after renal transplantation are high in China, but the prognosis can be better after active intervention is conducted. The onset symptoms are relatively insidious, so patients with high risk factors should be actively and effectively prevented, and cystoscopy should be performed regularly. Sirolimus may be considered as an immunosuppressant of new bladder tumors occur. BCG may be a better option for bladder perfusion, but more studies are needed.
-
Key words:
- renal transplantation /
- bladder cancer /
- prevention /
- treatment
-
-
表 1 10例肾移植术后新发膀胱肿瘤患者的一般资料
序号 性别 肾移植年龄/岁 原发疾病 移植术后至膀胱肿瘤确诊时间/月 手术方法(初次) 存活 预后 移植肾功能 术后病理(最终) P1 女 59 未经病理证实的肾小球肾炎 220 经尿道膀胱肿瘤电切术 至今 好转 带功 高级别乳头状尿路上皮癌 P2 女 57 未经病理证实的肾小球肾炎 121 经尿道膀胱肿瘤电切术 至今 复发 失功 低级别乳头状尿路上皮癌(局灶性呈高级别) P3 男 41 未经病理证实的肾小球肾炎 211 经尿道膀胱肿瘤电切术 至今 复发 带功 高级别乳头状尿路上皮癌 P4 女 63 不明 171 经尿道膀胱肿瘤电切术 至今 好转 带功 高级别乳头状尿路上皮癌 P5 女 49 高血压、高尿酸 92 经尿道膀胱肿瘤电切术 至今 好转 带功 高级别乳头状尿路上皮癌 P6 男 40 不明 236 经尿道膀胱肿瘤电切术 至今 好转 带功 高级别乳头状尿路上皮癌 P7 女 52 不明 90 经尿道膀胱肿瘤电切术 至今 复发 带功 高级别乳头状尿路上皮癌 P8 女 53 未经病理证实的肾小球肾炎 157 经尿道膀胱肿瘤电切术 至今 好转 带功 低级别乳头状尿路上皮癌 P9 男 56 高血压 7 经尿道膀胱肿瘤电切术 至今 复发 带功 高级别乳头状尿路上皮癌 P10 女 39 未经病理证实的肾小球肾炎 34 经尿道膀胱肿瘤电切术 至今 好转 带功 低级别乳头状尿路上皮癌 
下载: 导出CSV
表 2 4例肾移植术后新发膀胱肿瘤患者术后复发的资料
序号 性别 初次治疗 第1次复发 第2次复发 症状/发现 距肾移植初次发生时间/月 手术方法(初次) 症状/发现 复发间隔时间/月 手术方法(第2次) 症状/发现 二次复发时间/月 手术方法(第3次) P2 女 膀胱镜检查发现膀胱占位 121 经尿道膀胱肿瘤电切术 无痛肉眼血尿1个月余 42 腹腔镜辅助下行左肾+输尿管全长切除术+经尿道膀胱肿瘤电切术 - P3 男 超声发现膀胱占位20余天 211 经尿道膀胱肿瘤电切术 膀胱镜检查发现膀胱占位 8 经尿道膀胱肿瘤电切术 - P7 女 血尿 90 经尿道膀胱肿瘤电切术 膀胱镜检查发现膀胱占位 41 右半侧尿路切除术+经尿道膀胱肿瘤电切术 膀胱镜检查发现膀胱占位 14 经尿道膀胱肿瘤电切术+移植肾输尿管探查、再植术+双J管置入术 P9 男 膀胱镜检查发现膀胱占位 7 经尿道膀胱肿瘤电切术 膀胱镜检查发现膀胱占位 3 经尿道膀胱肿瘤电切术 -
下载: 导出CSV
-
[1] Cox J, Colli JL. Urothelial cancers after renal transplantation[J]. Int Urol Nephrol, 2011, 43(3): 681-686. doi: 10.1007/s11255-011-9907-z
[2] 王超, 李涛, 张健, 等. 中国肾移植术后并发恶性肿瘤趋势分析[J]. 器官移植, 2015, 6(3): 169-173. https://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201503009.htm
[3] Palazzetti A, Bosio A, Dalmasso E, et al. De Novo Bladder Urothelial Neoplasm in Renal Transplant Recipients: A Retrospective, Multicentered Study[J]. Urol Int, 2018, 100(2): 185-192. doi: 10.1159/000481917
[4] 张健, 马麟麟, 解泽林, 等. 我国肾移植术后新发恶性肿瘤总结分析[J]. 中华器官移植杂志, 2014, 35(12): 705-710. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZJKX201311007468.htm
[5] Querido S, Fernandes I, Weigert A, et al. High-grade urothelial carcinoma in a kidney transplant recipient after JC virus nephropathy: The first evidence of JC virus as a potential oncovirus in bladder cancer[J]. Am J Transplant, 2020, 20(4): 1188-1191. doi: 10.1111/ajt.15663
[6] Huang GL, Luo HL, Chen YT, et al. Oncologic Outcomes of Post-Kidney Transplantation Superficial Urothelial Carcinoma[J]. Transplant Proc, 2018, 50(4): 998-1000. doi: 10.1016/j.transproceed.2018.01.031
[7] 陈好雨, 周华, 贾志缃, 等. 肾移植术后合并恶性肿瘤的临床特征及危险因素分析[J]. 中国药物与临床, 2021, 21(21): 3533-3535. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202121009.htm
[8] Liu S, Chaudhry MR, Berrebi AA, et al. Polyomavirus Replication and Smoking Are Independent Risk Factors for Bladder Cancer After Renal Transplantation[J]. Transplantation, 2017, 101(6): 1488-1494. doi: 10.1097/TP.0000000000001260
[9] Jue JS, Alameddine M, González J, et al. Risk factors, management, and survival of bladder cancer after kidney transplantation[J]. Actas Urol Esp(Engl Ed), 2021, 45(6): 427-438. doi: 10.1016/j.acuro.2020.09.014
[10] Kanaan N, Hassoun Z, Raggi C, et al. Long-term Outcome of Kidney Recipients Transplanted for Aristolochic Acid Nephropathy[J]. Transplantation, 2016, 100(2): 416-421. doi: 10.1097/TP.0000000000000941
[11] Myung J, Choi JH, Yi JH, et al. Cancer incidence according to the National Health Information Database in Korean patients with end-stage renal disease receiving hemodialysis[J]. Korean J Intern Med, 2020, 35(5): 1210-1219. doi: 10.3904/kjim.2018.400
[12] Jin Y, Zhou Y, Deng W, et al. Genome-wide profiling of BK polyomavirus integration in bladder cancer of kidney transplant recipients reveals mechanisms of the integration at the nucleotide level[J]. Oncogene, 2021, 40(1): 46-54. doi: 10.1038/s41388-020-01502-w
[13] Hickman LA, Sawinski D, Guzzo T, et al. Urologic malignancies in kidney transplantation[J]. Am J Transplant, 2018, 18(1): 13-22. doi: 10.1111/ajt.14533
[14] Kawahara T, Kashiwagi E, Ide H, et al. Cyclosporine A and tacrolimus inhibit bladder cancer growth through down-regulation of NFATc1[J]. Oncotarget, 2015, 6(3): 1582-1593. doi: 10.18632/oncotarget.2750
[15] Ide H, Inoue S, Mizushima T, et al. Role of glucocorticoid signaling in urothelial tumorigenesis: Inhibition by prednisone presumably through inducing glucocorticoid receptor transrepression[J]. Mol Carcinog, 2019, 58(12): 2297-2305. doi: 10.1002/mc.23118
[16] Rodriguez Faba O, Palou J, Vila Reyes H, et al. Treatment options and predictive factors for recurrence and cancer-specific mortality in bladder cancer after renal transplantation: A multi-institutional analysis[J]. Actas Urol Esp, 2017, 41(10): 639-645. doi: 10.1016/j.acuro.2017.05.007
[17] Ishiyama Y, Yoshida K, Iizuka J, et al. Robot-Assisted Radical Cystectomy With Orthotopic Neobladder as a Urinary Diversion for a Kidney Transplant Recipient: A Case Report[J]. Transplant Proc, 2020, 52(2): 608-613. doi: 10.1016/j.transproceed.2019.12.002
[18] Demirdag C, Citgez S, Talat Z, et al. Management of Bladder Cancer After Renal Transplantation[J]. Transplant Proc, 2017, 49(2): 293-296. doi: 10.1016/j.transproceed.2016.11.039
[19] Pradere B, Schuettfort V, Mori K, et al. Management of de-novo urothelial carcinoma in transplanted patients[J]. Curr Opin Urol, 2020, 30(3): 467-474.
[20] Alkassis M, Abi Tayeh G, Khalil N, et al. The safety and efficacy of Bacillus Calmette-Guerin intravesical therapy in kidney transplant recipients with superficial bladder cancer[J]. Clin Transplant, 2021, 35(7): e14377.
-
| 引用本文: |
宋醒, 何龙, 杨宏伟. 肾移植术后新发膀胱肿瘤10例临床分析并文献复习[J]. 临床泌尿外科杂志, 2023, 38(4): 300-304. doi: 10.13201/j.issn.1001-1420.2023.04.013
|
| Citation: |
SONG Xing, HE Long, YANG Hongwei. Bladder cancer following renal transplantation in 10 cases: literatures review[J]. J Clin Urol, 2023, 38(4): 300-304. doi: 10.13201/j.issn.1001-1420.2023.04.013
|