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. 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. 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-GuÃ©rin and 20 (68.9%) mitomycin C. At univariate analysis, patients who received bacillus Calmette-GuÃ©rin had a signiï¬cantly lower recurrence rate (P =.043). At multivariate analysis, a switch from immunosuppression to mTOR inhibitors signiï¬cantly 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%. Conclusions Adjuvant bacillus Calmette-GuÃ©rin signiï¬cantly reduces the risk of recurrence, as does switch to mTOR inhibitors. Multiple tumors increase the risk.
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|Titolo:||Opciones terapÃ©uticas y factores predictivos de recurrencia y mortalidad cÃ¡ncer-especÃï¬ca en pacientes con tumor vesical despuÃ©s de trasplante renal: anÃ¡lisis multiinstitucional|
|Data di pubblicazione:||2017|
|Appare nelle tipologie:||01.01 - Articolo su rivista|