Context

Renal transplantation is the gold standard renal replacement therapy in end-stage renal disease owing to its superior survival and quality of life compared with dialysis. When the potential recipient has a history of cancer, the waiting period before renal transplantation is usually based on the Cincinnati Registry.

Objective

To systematically review all available evidence on the risk of cancer recurrence in end-stage renal disease patients with a history of urological cancer.

Evidence acquisition

Medline, Embase, and the Cochrane Library were searched up to March 2017 for all relevant publications reporting oncologic outcomes of urological cancer in patients who subsequently received a transplantation or remained on dialysis. The primary outcome was time to tumour recurrence. Secondary outcomes included cancer-specific and overall survival. Data were narratively synthesised in light of methodological and clinical heterogeneity. The risk of bias of each included study was assessed.

Evidence synthesis

Thirty-two retrospective studies enrolling 2519 patients (1733 dialysed, 786 renal transplantation) were included. For renal cell carcinomas, the risks of recurrence, cancer-specific, and overall survival were similar between transplantation and dialysis. For prostate cancer, most of the tumours had favourable prognoses consistent with nomograms. Studies dealing with urothelial carcinomas (UCs) mainly included upper urinary tract UC in the context of aristolochic acid nephropathy, for which the risks of synchronous bilateral tumour and recurrence were high. Data on testicular cancer were scarce.

Conclusions

Immunosuppression after renal transplantation does not affect the outcomes and natural history of low-risk renal cell carcinomas and prostate cancer. Therefore, the waiting time from successful treatment for these cancers to transplantation could be reduced. Except in the particular situation of aristolochic acid nephropathy, more studies are needed to standardise the waiting period after UC owing to the paucity of data.

Patient summary

Renal transplantation does not appear to increase the risk of recurrence of renal carcinoma or the recurrence of low-risk prostate cancer compared with dialysis. More reliable evidence is required to recommend a standard waiting period especially for urothelial and testicular carcinomas.

中文翻译：

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泌尿系癌症既往治疗后接受终末期肾脏疾病肾脏移植的患者发生肿瘤复发的风险：系统评价

语境

肾移植是终末期肾脏疾病的金标准肾替代疗法，因为它与透析相比具有更高的生存率和生活质量。当潜在的接受者有癌症病史时，肾移植前的等待期通常基于辛辛那提登记处。

客观的

为了系统地审查所有有泌尿科癌症病史的终末期肾病患者癌症复发风险的可用证据。

取证

截至2017年3月，在Medline，Embase和Cochrane库中搜索了所有相关出版物，这些出版物报告了随后接受移植或仍在接受透析的患者泌尿系统肿瘤的肿瘤学结局。主要结果是肿瘤复发的时间。次要结果包括癌症特异性生存期和总体生存期。根据方法和临床异质性对数据进行叙述性综合。评估每个纳入研究的偏倚风险。

证据综合

纳入了32项回顾性研究，招募了2519例患者（1733例透析，786例肾移植）。对于肾细胞癌，移植和透析之间的复发风险，癌症特异性风险和总体生存率相似。对于前列腺癌，大多数肿瘤的预后良好，符合列线图。关于尿路上皮癌（UCs）的研究主要包括马兜铃酸肾病中的上尿路UC，因此同步性双侧肿瘤和复发的风险很高。关于睾丸癌的数据很少。

结论

肾移植后的免疫抑制作用不会影响低危肾细胞癌和前列腺癌的预后和自然病程。因此，可以减少从成功治疗这些癌症到移植的等待时间。除了马兜铃酸肾病的特殊情况外，由于缺乏数据，还需要进行更多的研究以规范UC术后的等待时间。

病人总结

与透析相比，肾移植似乎并未增加肾癌复发或低危前列腺癌复发的风险。需要更可靠的证据来推荐标准的等待时间，尤其是对于尿路上皮和睾丸癌。