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

摘要：

目的 分析肿瘤病理分级对肾移植术后尿路上皮癌患者预后的影响。方法 本研究纳入了自1997 年 1 月至 2021 年 12 月在首都医科大学附属北京友谊医院泌尿外科接受手术并经病理诊断为尿路上皮癌的肾移植受者共 90 例。收集了患者的年龄、性别、移植至肿瘤发生的时间、免疫抑制剂使用情况、肿瘤发生部位、肿瘤 TNM 分期、肿瘤病理分级、肿瘤多发性及术后生存及复发等预后情况。本研究将肾移植术后发生尿路上皮癌的受者根据肿瘤发生部位分为非肌层浸润性膀胱癌、上尿路尿路上皮癌、上尿路尿路上皮癌 + 膀胱癌三部分。每部分根据患者的肿瘤病理分级，分为高级别肿瘤组与非高级别肿瘤组，分别对比了两组间主要的临床特征差异，然后分别分析了两组间肾移植受者的预后情况。结果 发生非肌层浸润性膀胱癌的有11 例，其中高级别肿瘤的有 5 例，高级别肿瘤与非高级别肿瘤在年龄（P ＝ 0.081）、性别（P ＝ 0.242）、接受移植至肿瘤发生的时间（P ＝ 0.734）及肿瘤多发性（P ＝ 0.545）上均无显著差异。仅有 1 例非高级别肿瘤患者在发生肿瘤 85 个月后死亡，其余受者在随访期间内均存活。发生上尿路尿路上皮癌的患者有 49 例，其中高级别肿瘤的有 38 例，两组间在年龄（P ＝ 0.951）、性别（P ＝ 0.400）、接受移植至肿瘤发生的时间（P ＝ 0.206）、肿瘤多发性（P ＝ 0.729）、T 分期（P ＝ 0.073）上均无显著差异。同时发生上尿路尿路上皮癌 + 膀胱癌的有 30 例，其中肿瘤为高级别肿瘤的有 13 例，两组间在年龄（P ＝ 0.741）、性别（P ＝ 0.355）、接受移植至肿瘤发生的时间（P ＝ 0.783）、T 分期（P ＝ 0.488）上均无显著差异。高级别肿瘤患者的总生存期显著高于非高级别肿瘤患者（P ＝ 0.006）。两组在复发方面无显著差异。结论 本研究发现仅有当肿瘤同时在膀胱及上尿路同时发生时，高级别肿瘤是影响肾移植受者预后的高危因素，而当肿瘤仅发生在膀胱或上尿路时对患者的预后影响较小。

关键词: 肾移植 , 病理 , 预后 , 移行细胞癌