Abstract:

Objective To investigate the clinical value of prophylactic contralateral nephroureterectomy in kidney transplant recipients with unilateral upper tract urothelial carcinoma（UTUC） and its impact on prognosis. Methods A retrospective analysis was conducted on clinical data from 49 patients with unilateral UTUC after kidney transplantation at Beijing Friendship Hospital， Capital Medical University between 2002 and 2021. Patients were divided into two groups: the prophylactic group （15 cases undergoing contralateral prophylactic nephroureterectomy） and the non-prophylactic group （34 cases without the procedure）. Overall survival， relapse-free survival， and progressionfree survival were compared between the groups. Multivariable Cox regression analysis was performed to evaluate the independent prognostic significance of prophylactic surgery. Results The baseline characteristics were balanced between the two groups， except that the median time from transplantation to tumor occurrence was significantly shorter in the prophylactic resection group compared to the non-resection group （54 vs. 119 months，P ＝ 0.004）. Survival analysis revealed that the prophylactic resection group exhibited longer median overall survival and progression-free survival than the non-resection group （91 vs. 69.5 months，P ＝ 0.422；69 vs. 31.5 months，P ＝ 0.462）， without statistically significant. However， recurrence-free survival was significantly prolonged in the prophylactic resection group （72 vs. 22 months，P ＝ 0.013）. Multivariate analysis confirmed that prophylactic resection served as an independent protective factor against contralateral urinary tract tumor recurrence （HR＝0.241，95% CI＝0.070～0.825，P＝0.024）. Conclusion Patients with unilateral UTUC after kidney transplantation have an increased risk of contralateral tumor occurrence. Prophylactic contralateral urinary tract resection may facilitate earlier detection of recurrence and progression， potentially improving survival outcomes. Further studies with larger sample sizes are needed to validate these findings. 

Key words:

"> Kidney transplantation ； , Upper tract urothelial carcinoma ；Nephroureterectomy ； , Survival prognosis； , Aristolochic acid nephropathy； , Tumor recurrence

摘要：

目的 探讨肾移植受者单侧上尿路上皮癌行对侧预防性肾输尿管切除术的临床价值及其对预后的影响。方法 回顾性分析 2002 — 2021 年于首都医科大学附属北京友谊医院收治的 49 例肾移植术后单侧UTUC 患者的临床数据，其中预切组内（行对侧预防性肾输尿管切除术的患者）共 15 例，未预切组内（未行对侧预防性肾输尿管切除术的患者）共 34 例，比较两组总生存期、无复发生存期及无进展生存期差异，并通过多变量 Cox 回归分析评估预防性切除的独立预后意义。结果 两组基线资料特征均衡，预切组内移植至肿瘤发生时间显著短于非预切组（中位 54 个月比 119 个月，P ＝ 0.004）。生存分析显示，预切组内中位 OS 及中位 PFS 大于非预切组中位 OS 与中位 PFS，但二者间无显著差异（91 个月比 69.5 个月，P ＝ 0.422 ；69 个月比 31.5 个月，P ＝ 0.462），预切组 RFS（72 个月比 22 个月，P ＝ 0.013）显著延长。多因素分析证实预防性切除是降低对侧尿路肿瘤复发概率的独立保护因素（HR ＝ 0.241，95%CI ＝ 0.070 ～ 0.825，P ＝ 0.024）。结论 肾移植后单侧 UTUC 患者行对侧上尿路预防性切除手术可以帮助降低肿瘤复发概率，延长肿瘤进展时间，改善患者的生存预后，但未来尚需扩大样本量以深化结论。

关键词: 肾移植 , 上尿路上皮癌 , 肾切除术 , 生存预后 , 马兜铃酸肾病 , 肿瘤复发