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723 De novo bladder urothelial neoplasm in renal transplant recipients: A retrospective multicentric study
723
De novo bladder urothelial neoplasm in renal transplant recipients: A retrospective multicentric study Eur Urol Suppl 2016;15(3);e723
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Bosio A. 1 , Palazzetti A. 1 , Dalmasso E. 1 , Alessandria E. 1 , Peretti D.1 , Destefanis P. 1 , Lillaz B. 1 , Pasquale G.1 , Sedigh O.1 , Fop F.2 , Volpe A. 3 , Di Domenico A. 4 , Iesari S. 5 , Todeschini P. 6 , Famulari A. 7 , Scolari M. 6 , Stratta P. 4 , Terrone C.3 , Segoloni G.P. 2 , Biancone L. 2 , Gontero P. 1 , Frea B. 1 1 A.O.U.
Città Della Salute E Della Scienza - Molinette Hospital, Dept. of Urology, Turin, Italy, 2 A.O.U. Città Della Salute E Della Scienza -
Molinette Hospital, Dept. of Nephrology and Renal Transplantation, Turin, Italy, 3 Maggiore Della Carità Hospital, Dept. of Urology, Novara, Italy, 4 Maggiore Della Carità Hospital, Dept. of Nephrology and Renal Transplantation, Novara, Italy, 5 San Salvatore Hospital, Dept. of Nephrology and Dialysis, L'Aquila, Italy, 6 Alma Mater Hospital, Dept. of Nephrology and Dialysis, Bologna, Italy, 7 San Salvatore Hospital, Dept. of Nephrology and Dialysis, L'aquila, Italy INTRODUCTION & OBJECTIVES: Renal Transplantation (RT) is the treatment of choice of End-Stage Renal Disease (ESRD) and the one that gives the best results in terms of quality of life. Renal Transplant Recipients (RTRs) however have a 2-7 fold risk of developing a neoplasm compared to general non-transplanted population mainly because of immunosuppressive treatment. Bladder urothelial neoplasms are rarely reported with an incidence of 0.4-2% but many reports describe a more aggressive behaviour compared to general population addressing the need to consider more aggressive treatments ab initio. The objective of the present study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression and survival rates. MATERIAL & METHODS: A retrospective multicentric study was performed involving 4 Renal Transplants Centres and evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis was performed as well as evaluation of recurrence, progression and survival rates according to commonly accepted risk factors: sex, age at diagnosis, immunosuppressive treatment, dialysis years, change in immunosuppressive therapy, and EORTC risk groups. Pearson’s Chi square test and Fisher modified test were used to compare groups. Significance level was set at p<0.05. RESULTS: 28 de novo bladder Transitional Cell Carcinomas (TCC) were identified, accounting for an incidence of 0.9%. At presentation 23 were Non-Muscle-Invasive Bladder Cancer (NMIBC), 2 were Muscle-Invasive (MIBC) and for 3 there were no staging information available. Overall Survival (OS) rates at 1, 2, 5 and 10 years were 100%, 87%, 78%, and 40% respectively. Cancer specific survival (CSS) rates were 100%, 87%, 75% and 70% after 1,2,5 and 10 years respectively. 5 patients (17.8%) died of TCC at a mean follow-up of 18 months. All CS deaths belonged to NMI high-risk group and all were patients who progressed from NMIBC to MIBC. Recurrence rate was 64% overall. Among all variables analysed the only one significantly influencing recurrence rate was age at diagnosis with an Odds Ratio (OR) of 10.4 (range 1.6-66.8; p=0.016). All other variables analysed were not statistically significant. Progression rate was 14%. Overall 4 (17,4%) NMIBC underwent progression at the last available follow-up. Sex, immunosuppression years, age at diagnosis and dialysis years were not statistically significantly related to progression. On the other hand CIS was significantly associated with progression to MIBC (OR=18, range 1.3-235.7, p=0.03). Immunosuppressive treatment change after TCC diagnosis was not associated either with lower recurrence or with lower progression rates. CONCLUSIONS: Bladder urothelial neoplasms following RT were associated with a trend toward worst prognosis, mainly in those patients who had a primary high-risk NMIBC. Early aggressive treatments, such as early radical cystectomy might be advisable to reduce progression to MIBC and cancer-specific death.
De novo bladder urothelial neoplasm in renal transplant recipients: A retrospective multicentric study Eur Urol Suppl 2016;15(3);e723
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Bosio A. 1 , Palazzetti A. 1 , Dalmasso E. 1 , Alessandria E. 1 , Peretti D.1 , Destefanis P. 1 , Lillaz B. 1 , Pasquale G.1 , Sedigh O.1 , Fop F.2 , Volpe A. 3 , Di Domenico A. 4 , Iesari S. 5 , Todeschini P. 6 , Famulari A. 7 , Scolari M. 6 , Stratta P. 4 , Terrone C.3 , Segoloni G.P. 2 , Biancone L. 2 , Gontero P. 1 , Frea B. 1 1 A.O.U.
Città Della Salute E Della Scienza - Molinette Hospital, Dept. of Urology, Turin, Italy, 2 A.O.U. Città Della Salute E Della Scienza -
Molinette Hospital, Dept. of Nephrology and Renal Transplantation, Turin, Italy, 3 Maggiore Della Carità Hospital, Dept. of Urology, Novara, Italy, 4 Maggiore Della Carità Hospital, Dept. of Nephrology and Renal Transplantation, Novara, Italy, 5 San Salvatore Hospital, Dept. of Nephrology and Dialysis, L'Aquila, Italy, 6 Alma Mater Hospital, Dept. of Nephrology and Dialysis, Bologna, Italy, 7 San Salvatore Hospital, Dept. of Nephrology and Dialysis, L'aquila, Italy INTRODUCTION & OBJECTIVES: Renal Transplantation (RT) is the treatment of choice of End-Stage Renal Disease (ESRD) and the one that gives the best results in terms of quality of life. Renal Transplant Recipients (RTRs) however have a 2-7 fold risk of developing a neoplasm compared to general non-transplanted population mainly because of immunosuppressive treatment. Bladder urothelial neoplasms are rarely reported with an incidence of 0.4-2% but many reports describe a more aggressive behaviour compared to general population addressing the need to consider more aggressive treatments ab initio. The objective of the present study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression and survival rates. MATERIAL & METHODS: A retrospective multicentric study was performed involving 4 Renal Transplants Centres and evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis was performed as well as evaluation of recurrence, progression and survival rates according to commonly accepted risk factors: sex, age at diagnosis, immunosuppressive treatment, dialysis years, change in immunosuppressive therapy, and EORTC risk groups. Pearson’s Chi square test and Fisher modified test were used to compare groups. Significance level was set at p<0.05. RESULTS: 28 de novo bladder Transitional Cell Carcinomas (TCC) were identified, accounting for an incidence of 0.9%. At presentation 23 were Non-Muscle-Invasive Bladder Cancer (NMIBC), 2 were Muscle-Invasive (MIBC) and for 3 there were no staging information available. Overall Survival (OS) rates at 1, 2, 5 and 10 years were 100%, 87%, 78%, and 40% respectively. Cancer specific survival (CSS) rates were 100%, 87%, 75% and 70% after 1,2,5 and 10 years respectively. 5 patients (17.8%) died of TCC at a mean follow-up of 18 months. All CS deaths belonged to NMI high-risk group and all were patients who progressed from NMIBC to MIBC. Recurrence rate was 64% overall. Among all variables analysed the only one significantly influencing recurrence rate was age at diagnosis with an Odds Ratio (OR) of 10.4 (range 1.6-66.8; p=0.016). All other variables analysed were not statistically significant. Progression rate was 14%. Overall 4 (17,4%) NMIBC underwent progression at the last available follow-up. Sex, immunosuppression years, age at diagnosis and dialysis years were not statistically significantly related to progression. On the other hand CIS was significantly associated with progression to MIBC (OR=18, range 1.3-235.7, p=0.03). Immunosuppressive treatment change after TCC diagnosis was not associated either with lower recurrence or with lower progression rates. CONCLUSIONS: Bladder urothelial neoplasms following RT were associated with a trend toward worst prognosis, mainly in those patients who had a primary high-risk NMIBC. Early aggressive treatments, such as early radical cystectomy might be advisable to reduce progression to MIBC and cancer-specific death.