肾移植受者术后并发泌尿系统恶性肿瘤(附12例报告)

Malignant tumor of urinary system in renal allograft recipients in one-center

目的分析肾移植受者术后并发泌尿系统恶性肿瘤的特点。方法回顾性分析1978年6月至2006年8月间3150例肾移植受者的临床资料,研究受者肾移植术后泌尿系统恶性肿瘤的发生率、发病年龄、发生时间以及免疫抑制剂的应用情况和肿瘤的治疗方案等。结果在3150例肾移植受者中,肾移植术后共发生33例(发生率1.05%)恶性肿瘤,其中泌尿系统恶性肿瘤12例(发生率0.38%),占肾移植术后恶性肿瘤的36.4%。这12例患者的发病年龄为48～66岁,平均(58.3±4.6)岁;肾移植术后发生肿瘤的平均时间为(62±18)个月;肾移植术后免疫抑制剂方案为:6例服用环孢素A+硫唑嘌呤+泼尼松,5例服用环孢素A+霉酚酸酯+泼尼松,1例服用他克莫司+霉酚酸酯+泼尼松。肿瘤发生后,12例患者中有11例施行了肿瘤根治性手术,其中1例在根治术后不久因突发脑溢血死亡。结论泌尿系统恶性肿瘤是肾移植受者术后的一个重要并发症;免疫抑制剂的使用与肿瘤的发生密切相关。因此,应定期评估肾移植受者术后的免疫状态,早期发现肿瘤,及时手术治疗,并适当减少免疫抑制剂用量。

Objective To analyze the epidemiographic features of malignant tumors of urinary system in renal allograft recipients in our center. Methods A retrospective analysis was performed on 3150 patients who received renal transplantation between June 1978 and Autumn 2006. Twelve cases of urinary tumors were selected for study. Results Among 3150 recipients, 33 （1.05 %） were diagnosed as malignancies including 12 （0.38 %） cases in urinary system. The mean age of these patients when diagnosed as urinary tumors was 58. 3 ± 4. 6 （range 48-66）. The mean duration of immunosuppressive treatment was 62 ± 18 （range 26-120） months. Six cases received cyclosporine A ＋ azalthioprine ＋ prednisone （CsA ＋ Aza ＋ Pred）, 5 cases cyclosporine A ＋ mycophenolate mofetil ＋ prednisone （CsA ＋ MMF ＋ Pred）, and one case tacrolimus ＋ mycophenolate mofetil ＋ prednisone （FK506 ＋ MMF ＋ Pred）. Surgical treatment was carried out in 11 patients. Ten of them were still alive. One case died of cerebral hemorrhage. Conclusions Malignant tumors of urinary system, especially TCC is an important complication in renal transplantation in our center. The occurrence of malignant tumors is intimately related to immunosuppressive treatment. The immunological status of patients after renal transplantation should be evaluated in follow-up studies. The treatment consists of complete resection of the mass, decreases of irnmunosuppressants, chemotherapy or radiotherapy.