关键词: 肾移植 , 病理 , 预后 , 移行细胞癌

Abstract:

Objective To analyze the influence of tumor pathological grade on the prognosis of patientswith urothelial carcinoma （UC） after kidney transplantation （KT）. Methods A total of 90 KT recipients whounderwent surgery and were pathologically diagnosed as UC in the Department of Urology， Beijing Friendship Hospital，Capital Medical University from January 1997 to December 2021 were included in this study. The patients' age，gender， time from transplantation to tumor occurrence， immunosuppressant use， tumor location， tumor TNM stage，tumor pathological grade， tumor multiplicity， postoperative survival and recurrence were collected. The patients in this study， the recipients who developed UC after KT were divided into three groups according to the location of the tumor ： non muscle invasive bladder cancer， upper urinary tract urothelial carcinoma， and utuc+ bladder cancer. Eachgroup was divided into high-grade tumor group and non-high-grade tumor group according to the tumor pathological grade of the patients. The main differences in clinical characteristics between the two groups were compared， and then the prognosis of KT recipients between the two groups was analyzed. Results There were 11 cases of non-muscle invasive bladder cancer and 5 cases of high-grade tumor. There were no significant differences in age （P ＝0.081）， gender （P ＝ 0.242）， time from transplantation to tumor occurrence （P ＝ 0.734） and tumor multiplicity （P ＝ 0.545） between high-grade tumor and non-high-grade tumor groups. Only one patient with non-high-grade

tumor died 85 months after the occurrence of tumor， and the rest of the recipients survived during the follow-up period. There were 49 cases of upper urinary tract urothelial carcinoma and 38 cases of high-grade tumor. There were no significant differences in age （P ＝ 0.951）， gender （P = 0.400）， time from transplantation to tumor occurrence （P ＝ 0.206）， tumor multiplicity （P ＝ 0.729）， and T stage （P = 0.073） between the two groups. There were 30 cases of upper urinary tract urothelial carcinoma + bladder cancer at the same time， including 13 cases of high-grade tumors. There were no significant differences in age （P ＝ 0.741）， gender （P ＝ 0.355）， time from transplantation to tumor occurrence（P ＝ 0.783）， and T stage （P ＝ 0.488） between the two groups. The overall survival of patients with high-grade tumors wassignificantly higher than that of patients with non high-grade tumors （P ＝ 0.006）. There was no significant difference inrecurrence between the two groups. Conclusion This study found that high-grade tumor was a high-risk factor affecting the prognosis of KT recipients only when the tumor occurred simultaneously in the bladder and upper urinary tract， while it had little impact on the prognosis of patients when the tumor occurred only in the bladder or upper urinary tract. 

Key words:

Kidney transplantation； , Pathology； , Prognosis； , Transitional cell carcinoma