De Novo Bladder Urothelial Neoplasm in Renal Transplant Recipients: A Retrospective, Multicentered Study

Abstract

Background and Objectives: Renal transplant recipients (RTRs) have a 2- to 7-fold risk of developing a neoplasm compared to general population. Bladder urothelial neoplasms in this cohort has an incidence of 0.4–2%. Many reports describe a more aggressive behavior. The objective of this study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression, and survival rates. Methods: A retrospective multicentered study was performed evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis and evaluation of recurrence, progression, and survival rates were performed. Results: A total of 28 de novo bladder transitional cell carcinomas (TCCs) were identified (incidence rate 0.64%). Cancer-specific survival rates were 100, 75, and 70% after 1, 5, and 10 years, respectively. Age at diagnosis superior to 60 years was found to be a statistically significant variable for recurrence risk. Progression rate was 14%. Presence of CIS was significantly associated with progression. All cancer-specific deaths were in the high-risk group and all were progressions from non-muscle invasive to muscle invasive bladder cancer. Conclusions: Bladder urothelial neoplasms following renal transplant is associated with a trend toward worst prognosis. Early aggressive treatments, such as early radical cystectomy, might be advisable to reduce cancer-specific deaths.

Immune‐related conditions and cancer‐specific mortality among older adults with cancer in the United States

“…For bladder cancer, we found associations with reduced cancer‐specific survival for pernicious anemia and hemolytic anemia, which have not been reported previously and may represent effects of vitamin B 12 deficiency or treatment with immunosuppressive medications, respectively 36,37 . While intravesical treatment of bladder cancer with Bacillus Calmette‐Guérin is relatively contraindicated in immunocompromised patients due to concerns for disseminated infection and decreased effectiveness, 38 existing data on survival outcomes in such patients are sparse 39‐41 …”

Urological Cancers and Kidney Transplantation: a Literature Review

“…The mean time to develop UC after renal transplant ranges from 5.2 to 9.5 years [48,56,57,[59][60][61] with urothelial histology being present in 93% of the patients, while squamous and adenocarcinoma differentiation reach 3.4% each [61]. Hematuria is the most frequent clinical presentation (36.4-42.5%) [49,61,62]; however, some studies report incidental diagnosis in up to 50% of RTRs [61,62].…”

“…In RTRs up to 66.6% of UC are diagnosed in more advanced stages (i.e., ≥ T2 stage) with higher progression rates (RR 10.53; p = 0.0481) [59], in comparison to controls [48,60]. This aggressive behavior is due to a higher presence of carcinoma in situ (65%) [62,63] and tumor multifocality [63]. Furthermore, the chemokine ligand 18 (CCL18), also known as dendritic cell chemokine, is overexpressed in urothelial tumors of RTRs, as opposed to non-transplant patients; CCL18 upregulates migration and invasion of cancer cells [64].…”

“…One-and 5-year overall survival ranges from 60 to 100% and 36 to 59%, respectively [48,62], and depends on initial stage as well as BC aggressiveness; when comparing outcomes with non-transplant patients, no survival differences were found (p = 0.1186) [48,60]. However, there are reports of poor 1-year survival rates when patients have progression from non-invasive disease to muscle-invasive UC [62]. When comparing patients with ESRD and RTRs, the latter have a higher and earlier recurrence rate of NMIBC (p = 0.019) [73].…”

“…When comparing patients with ESRD and RTRs, the latter have a higher and earlier recurrence rate of NMIBC (p = 0.019) [73]. In RTRs, the mean time to first recurrence is 10.9 months, with 30% recurring at 1 year and 40% at 5 years [62]. Annual screening with graft and native kidneys ultrasound to rule out urothelial tumors is advised [74].…”