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Treatment options and predictive factors for recurrence and cancer-specific mortality in bladder cancer after renal transplantation: A multi-institutional analysis.
- Source :
-
Actas urologicas espanolas [Actas Urol Esp] 2017 Dec; Vol. 41 (10), pp. 639-645. Date of Electronic Publication: 2017 Nov 08. - Publication Year :
- 2017
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Abstract
- Objectives: Bladder cancer (BC) in the transplanted population can represent a challenge owing to the immunosuppressed state of patients and the higher rate of comorbidities. The objective was to analyze the treatment of BC after renal transplant (RT), focusing on the mode of presentation, diagnosis, treatment options and predictive factors for recurrence.<br />Material and Methods: We conducted an observational prospective study with a retrospective analysis of 88 patients with BC after RT at 10 European centers. Clinical and oncologic data were collected, and indications and results of adjuvant treatment reviewed. The Kaplan-Meier method and uni- and multivariate Cox regression analyses were performed.<br />Results: A total of 10,000 RTs were performed. Diagnosis of BC occurred at a median of 73 months after RT. Median follow-up was 126 months. Seventy-one patients (81.6%) had non-muscle invasive bladder cancer, of whom 29 (40.8%) received adjuvant treatment; of these, six (20.6%) received bacillus Calmette-Guérin and 20 (68.9%) mitomycin C. At univariate analysis, patients who received bacillus Calmette-Guérin had a significantly lower recurrence rate (P=.043). At multivariate analysis, a switch from immunosuppression to mTOR inhibitors significantly reduced the risk of recurrence (HR 0.24, 95% CI: 0.053-0.997, P=.049) while presence of multiple tumors increased it (HR 6.31, 95% CI: 1.78-22.3, P=.004). Globally, 26 patients (29.88%) underwent cystectomy. No major complications were recorded. Overall mortality (OM) was 32.2% (28 patients); the cancer-specific mortality was 13.8%.<br />Conclusions: Adjuvant bacillus Calmette-Guérin significantly reduces the risk of recurrence, as does switch to mTOR inhibitors. Multiple tumors increase the risk.<br /> (Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Subjects :
- Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local diagnosis
Postoperative Complications diagnosis
Prognosis
Prospective Studies
Retrospective Studies
Urinary Bladder Neoplasms diagnosis
Kidney Transplantation
Neoplasm Recurrence, Local epidemiology
Neoplasm Recurrence, Local therapy
Postoperative Complications mortality
Postoperative Complications therapy
Urinary Bladder Neoplasms mortality
Urinary Bladder Neoplasms therapy
Subjects
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 1699-7980
- Volume :
- 41
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Actas urologicas espanolas
- Publication Type :
- Academic Journal
- Accession number :
- 29126568
- Full Text :
- https://doi.org/10.1016/j.acuro.2017.05.007