Management of bladder cancer in kidney transplant recipients: A narrative review.

IF 1.2 4区医学 Q4 ONCOLOGY

Bladder Cancer Pub Date : 2025-02-24 eCollection Date: 2025-01-01 DOI:10.1177/23523735251321986

Khi Yung Fong, Ee Jean Lim, Wei Zheng So, Edwin Jonathan Aslim, Ho Yee Tiong, Valerie Huei Li Gan

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引用次数: 0

Abstract

Background: Bladder cancer in the setting of previous a kidney transplant (KT) is challenging to manage due to complex medical and surgical considerations.

Objective: To provide a comprehensive evaluation of the scope of management of bladder cancer in KT patients, and describe the controversies surrounding these management options.

Methods: A systematic review of studies reporting management of KT patients with bladder cancer and involving ≥3 patients was performed. A narrative review was also performed for various aspects of management such as pathophysiology, surgical considerations, intravesical therapy, immunosuppression and oncological surveillance.

Results: Bladder cancer incidence in KT recipients is 2.8-4.1 times higher than the general population, and there is a notable association with aristolochic acid nephropathy as well as BK virus oncogenesis. Regarding surgical treatment, transurethral resection is preferred for non-muscle invasive tumors, and intravesical BCG for intermediate- and high-risk patients appears to be underutilized despite its safety and associated reduction in recurrence. Radical cystectomy with limited pelvic lymph node dissection, urinary diversion, and consideration of bilateral nephroureterectomy appears to be the safest method of oncological control in muscle-invasive tumors. A switch in immunosuppressive regimens to mTOR inhibitors may be considered in lieu of its antitumor effects. Routine surveillance in KT patients with risk factors for bladder cancer is challenging and may be warranted especially in the Asian population which has a higher rate of urothelial malignancy.

Conclusions: This review provides a thorough summary of management strategies for bladder cancer in the setting of previous KT.

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肾移植受者膀胱癌的治疗：综述。

背景：由于复杂的医学和外科考虑，既往肾移植（KT）患者膀胱癌的治疗具有挑战性。目的：对KT患者膀胱癌的治疗范围进行综合评价，并描述围绕这些治疗方案的争议。方法：系统回顾涉及≥3例膀胱癌KT患者管理的研究。叙述回顾也进行了各个方面的管理，如病理生理学，手术考虑，膀胱内治疗，免疫抑制和肿瘤监测。结果：KT受体的膀胱癌发病率是普通人群的2.8 ~ 4.1倍，与马兜铃酸肾病和BK病毒致癌有显著相关性。关于外科治疗，经尿道切除是非肌肉侵袭性肿瘤是首选，而膀胱内卡介苗治疗中高危患者似乎没有得到充分利用，尽管其安全性和相关的复发减少。根治性膀胱切除术加有限的盆腔淋巴结清扫、尿转移和考虑双侧肾输尿管切除术似乎是肌肉侵袭性肿瘤最安全的肿瘤控制方法。可以考虑将免疫抑制方案转换为mTOR抑制剂，以取代其抗肿瘤作用。对具有膀胱癌危险因素的KT患者进行常规监测是具有挑战性的，特别是在尿路上皮恶性肿瘤发生率较高的亚洲人群中，可能需要进行常规监测。结论：本文综述了膀胱癌既往KT患者的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bladder Cancer Medicine-Urology

CiteScore

1.60

自引率

0.00%

发文量

期刊介绍： Bladder Cancer is an international multidisciplinary journal to facilitate progress in understanding the epidemiology/etiology, genetics, molecular correlates, pathogenesis, pharmacology, ethics, patient advocacy and survivorship, diagnosis and treatment of tumors of the bladder and upper urinary tract. The journal publishes research reports, reviews, short communications, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that expedites our fundamental understanding and improves treatment of tumors of the bladder and upper urinary tract.