肾移植术后泌尿系恶性肿瘤患者T淋巴细胞亚群的测定及意义

  目的  观察肾移植术后并发泌尿系统恶性肿瘤患者血液T淋巴细胞亚群的变化, 及其对调整免疫抑制剂及预防恶性肿瘤的意义。  方法  9例肾移植术后并发泌尿系统恶性肿瘤患者为肿瘤组, 9例未发生任何肿瘤或感染的肾移植患者为移植组, 9例健康体检者为对照组。流式细胞术测定T淋巴细胞亚群(CD3+T、CD3+CD8+T、CD3+CD4+T、CD4+/CD8+)比例, 肿瘤组行肿瘤切除并减少免疫抑制剂用量, 测定术前及术后2个月血药CsA和FK506浓度。  结果  肿瘤组与另两组比较, CD3+T及CD3+CD8+T无明显变化, CD3+CD4+T明显减少, CD4+/CD8+比值明显降低(P < 0.05)。肿瘤组肿瘤切除术后2个月与术前比较, CD3+T和CD3+CD4+T无明显变化; CD3+CD8+T明显降低, 而CD4+/CD8+比值明显升高(P < 0.05), CsA和FK506血药浓度均明显降低(P < 0.05)。  结论  血T淋巴细胞亚群可作为肾移植免疫状态的有效评价指标, 对指导肾移植免疫抑制剂的调整和预防肿瘤的发生具有重要的临床意义。      

基于OPTN和UNOS数据库分析2001-2019年肾移植术后恶性肿瘤发生影响因素

目的 分析肾移植术后恶性肿瘤发生的影响因素,为肾移植术后恶性肿瘤早发现、早治疗提供参考。方法 对美国器官获取和移植网络(OPTN)和器官共享联合网络(UNOS)数据库中2001-2019年肾移植受者进行回顾性研究,统计患者一般人口学资料、社会经济与教育学资料、个人既往病史及免疫抑制剂使用方案。按术后是否发生肿瘤进行分组,分别比较术后肿瘤组与术后无瘤组生存率、移植肾存活率及肿瘤发病影响因素。结果 共纳入294 422例肾移植受者,术后新发恶性肿瘤患者27 338例,总发病率为9.22%。其中肾移植术后常见恶性肿瘤前3位分别为皮肤鳞状细胞癌、皮肤基底细胞癌及肺癌,发病率分别为3.93%、1.19%、0.82%;移植后甲状腺癌肿瘤发生时间中位数最短,为3.09年。高龄、男性、白人、受者糖尿病及恶性肿瘤既往史、无商业保险、环孢素的使用是肾移植术后恶性肿瘤发生的危险因素,接受高等教育、多囊肾所致终末期肾病、活体移植、使用他克莫司及麦考酚酸的患者肾移植术后恶性肿瘤发生风险降低。肾移植术后恶性肿瘤患者5年生存率前3位分别是皮肤基底细胞癌(95.5%)、甲状腺癌(94.8%)、皮肤鳞状细胞癌(94.5...     

肾移植术后恶性肿瘤39例临床分析

目的分析总结肾移植术后恶性肿瘤的发生情况,探讨其诊断方法和治疗措施。方法回顾性分析1978年9月至2009年12月接受免疫抑制治疗的肾移植受者中恶性肿瘤的发生情况。结果1945例（2106例次）肾移植共发生恶性肿瘤39例,发生率为2％。恶性肿瘤于移植术后8～124个月（中位时间57个月）得到明确诊断,其中泌尿系统肿瘤22例,消化系统肿瘤8例,肺癌、淋巴瘤、乳腺癌各2例,硬脑膜小细胞癌、胸膜低分化癌各1例,另有1例转移性肝癌患者人院后3d死亡,原发肿瘤不明。28例获手术治疗,随访至2010年12月,生存16例,其余12例在术后3-96个月（中位时间33个月）死于肿瘤转移;11例未手术者于诊断后3d一36个月（中位时间5个月）死亡。结论肾移植受者中恶性肿瘤的发生以泌尿系统肿瘤最为多见,肿瘤恶性程度高,早期发现、早期治疗是提高生存率的关键,治疗上应尽早采取以手术为主的综合治疗。     

肾移植患者恶性肿瘤发病特征和危险因素

背景与目的:肾移植患者较一般人群易发生恶性肿瘤,且发病特征发生了根本的改变.本研究主要分析肾移植术后患者恶性肿瘤发病特征并探讨影响肿瘤发生的危险因素.方法:回顾性分析我院1991年1月至2007年8月2 392例肾移植患者中发生的31例患者的恶性肿瘤类型、肾移植时年龄、术后至肿瘤诊断时时间、免疫抑制剂应用情况进行分组比较和相关性分析.结果:肾抑制受者恶性肿瘤发生率为 1.29%,以消化道肿瘤为主(35.5%).恶性肿瘤发生率与肾移植时年龄正相关、与男性性别相关.免疫诱导组在恶性肿瘤诊断时肾功能不全发生率较非免疫诱导组明显降低,但肾移植术后至肿瘤诊断时间明显缩短,且患者1年生存率无明显改善.结论:肾移植受者恶性肿瘤发生率高于一般人群,肿瘤类型以肝癌、甲状腺癌和非何杰金淋巴瘤为主;免疫诱导、肾移植时年龄、男性是发生恶性肿瘤的危险因素.肾移植术后患者应进行个体化免疫抑制治疗,早期发现并诊断肿瘤,积极进行以根治性手术为主的综合治疗.     

肾移植术后并发泌尿系统肿瘤6例报告并文献复习

 目的　探讨肾移植术后泌尿系统肿瘤的发生情况、临床特点、诊断及治疗。方法　对本院自1991年～ 2 0 0 1年十年间行同种异体肾移植术 10 96例术后泌尿系统肿瘤的发生情况进行回顾性分析 ,并结合复习文献。结果　本组发现泌尿系统肿瘤 6例 ,发生率为 0 .5 5 %。其中肾盂癌 2例 (其中 1例为双侧肾盂癌 ) ,膀胱癌 1例 ,肾盂癌合并膀胱癌 2例 ,输尿管癌 1例。 6例均行手术治疗 ,平均随访11.4个月 ,效果良好。结论　肾移植术后出现血尿 ,除排斥反应外 ,还应注意泌尿系统肿瘤的可能性。     

肾移植受体术后免疫抑制剂治疗对新发恶性肿瘤发生率及影响因素分析

目的：分析肾移植术后长期服用免疫抑制剂治疗患者恶性肿瘤的发生率，并探讨患者新发恶性肿瘤的影 响因素，为肾移植术后免疫抑制剂治疗患者继发恶性肿瘤的早期诊断和防治提供参考依据。方法：回顾性收集 ２００７ 年 ８月至 ２０２０年 １２月期间在我院器官移植中心完成肾移植且术后免疫抑制剂治疗期间随访均已获得的肾移植受 体患者 １０２８例作为研究对象，随访患者恶性肿瘤的发病率，采用单因素分析及多因素 Ｌｏｇｉｓｔｉｃ回归模型探讨肾移植 受体术后长期服用免疫抑制剂治疗对新发恶性肿瘤的影响。结果：新发恶性肿瘤 ３０例，发生率为 ２．９２％。恶性肿 瘤确诊中位时间为肾移植术后 ５８（１２～１４４）个月，其中有 ５例（１６．６７％）在术后 ２年内发病、１１例（３６．６７％）在术后 ５年内发病、１４例（４６．６７％）在术后 ５年后发病。不同免疫抑制剂治疗方案患者恶性肿瘤的新发生率之间差异无统 计学意义（χ２＝１．７５８，Ｐ＝０．４１５）。单因素及多因素 Ｌｏｇｉｓｔｉｃ回归分析，结果显示：有肿瘤家族史、ＦＫ５０血药浓度高、 Ｔｒｅｇ细胞水平高是肾移植术后长期免疫抑制剂治疗患者新发恶性肿瘤的独立影响因素（Ｐ＜０．０５）。结论：肾移植术 后长期服用免疫抑制剂治疗患者的恶性肿瘤发病风险较高，肿瘤家族史、血药浓度、Ｔｒｅｇ细胞水平是其影响因素。     

肾移植术后恶性肿瘤:14例病例

目的总结肾移植术后恶性肿瘤的发生率、发生机制及治疗方法。方法回顾性分析我院1991～2006年间500例肾移植后并发恶性肿瘤的诊断、治疗情况。结果14例病例发生恶性肿瘤,占肾移植病例总数的2．8％。治疗方法包括：停用或减少部分免疫抑制剂的用量,更换免疫抑制剂的种类;手术切除肿瘤,辅以化疗和放疗。后者转归较佳。讨论要重视肾移植后病人发生肿瘤的问题。肾移植后个体化监测及治疗对术后并发恶性肿瘤患者有较大的帮助。     

肾盂恶性肿瘤诊治体会(附17例报告)

目的　探讨肾盂恶性肿瘤的诊治方法。方法　报告肾盂恶性肿瘤 17例 ,其中移行细胞癌 10例 ,移行上皮细胞及鳞状上皮细胞混合癌 2例 ,腺癌 2例 ,鳞癌合并肾结石 2例。 1例未行手术 ,2例探查活检 ,肾、全输尿管及膀胱袖状切除 12例 ,肾、输尿管部分切除 1例 ,肾、输尿管全切 1例。结果　随访 14例 ,随访时间 2月～ 5年 ,5年生存率 5 0 %。结论　静脉肾盂造影 (IVP)、CT及B超 ,为主要诊断方法 ;肾、全输尿管及膀胱袖状切除是主要治疗手段。     

肾移植术后发生泌尿系统多器官肿瘤4例报告

肾移植术后并发恶性肿瘤是肾移植术后一种严重的并发症,是影响患者长期生存的主要因素之一.肾移植术后发生泌尿系统多器官肿瘤报道较少,我们收治4例,现将其临床资料报告如下,以提高对肾移植患者并发泌尿系统多器官肿瘤的认识.     

肾盂恶性肿瘤治疗体会（附17例报告）

目的 探讨肾盂恶性肿瘤的诊治方法。方法 报告肾盂恶性肿瘤１７例,其中移行细胞癌１０例,移行上皮细胞及鳞状上皮细胞混合癌２例,腺癌２例,鳞癌合并肾结石２例。１例未行手术,２例探查活检,肾、全输尿管及膀胱袖状切除１２例,肾、输尿管部分切除１例,肾、输尿管全切１例。结果 随记１４例,随访时间２月￣５年,５年生存率５０％。结论 静脉肾盂造影（ＩＶＰ）、ＣＴ及Ｂ超,为主要诊断方法肾、全输尿管及膀胱袖状切除是     

Primary multiple cancers related to urological malignancies

In the course of 5 years, we encountered 11 cases of primary multiple cancers related to urological malignancies at the Department of Urology, Tokyo Metropolitan Komagome Hospital. The patient age at diagnosis of the first cancer ranged from 59 to 77 years (mean 69 years); there were 9 men and 2 women. Of patients with urological malignancies, 6.4% had multiple cancers. All cases were diagnosed clinically and diagnosis was confirmed histologically. In ten patients, second cancers were found within one year. Three cases were combined with urological cancers, six cases with gastric cancer. The clinical course of a patient with renal pelvic-ureteral cancer and gastric carcinoma is presented in detail.     

Assessment of microsatellite instability in urine in the detection of transitional-cell carcinoma of the bladder

Loss of heterozygosity (LOH) and alterations in microsatellite DNA markers have been reported in bladder-cancer tumors. We have studied, in a blinded fashion, using PCR-based microsatellite analysis, genetic alterations of cells exfoliated in urine of 59 Caucasian patients and control patients; 31 with initially confirmed bladder transitional-cell carcinoma (TCC), 17 with signs and symptoms suggestive of bladder cancer, 6 control patients who underwent renal transplantation, and 5 control patients with urolithiasis. Microsatellite analysis of cells exfoliated in the urine allowed the diagnosis of 83% (10/12) of patients with bladder TCC recurrence confirmed by cystoscopy, while 100% of patients followed up for transitional-cell carcinoma of the bladder for up to 12 months without evidence of tumor recurrence upon routine cystoscopy showed no microsatellite alterations. None of the patients without neoplasia (negative controls) had any microsatellite alterations, whereas all patients who underwent renal transplantation had additional new alleles corresponding to contamination with donor's renal and urothelial cells (positive controls). No control patients had any evidence of transitional-cell carcinoma by cystoscopy. Our results provide objective evidence that non-invasive molecular detection of bladder TCC by microsatellite analysis is reproducible with a sensitivity of 83% and a specificity of 100% in Caucasian patients. This non-invasive procedure represents a potential clinical tool for the detection and the screening of bladder TCC. Int. J. Cancer (Pred. Oncol.) 79:629–633, 1998. © 1998 Wiley-Liss, Inc.     

Immune parameters of peripheral blood in chemoembolization with microencapsulated anticancer drugs

To investigate possible immunological consequences after arterial infusion of microencapsulated anticancer drug (chemoembolization), cellular immune parameters in peripheral blood were monitored for 4 weeks after chemoembolization in 20 patients with urological malignancies including 7 renal cell carcinomas, 2 renal pelvic carcinomas, 8 bladder carcinomas and 3 prostatic carcinomas. Natural killer (NK) cell activity and OKT4/8 ratio were augmented in 67% and 83% of the cases after chemoembolization respectively. Mature NK cell population (Leu7-OKT 16+) in these cases also showed a trend of continuous increase for more than 4 weeks. On the other hand, a small number of the patients showed an augmentation of OKT3+ cells, Ia-1+ cells or response to phytohemagglutinin. Histopathological examination of regional lymph nodes in 9 patients who underwent chemoembolization for renal cell carcinoma showed stimulating reactions in 8, while lymphocyte depletion in 1. These findings suggest that inhibition of micrometastasis by the enhanced natural killer cell activity could be anticipated in more than half of cases after chemoembolization.     

肾移植受者中发生的恶性肿瘤

１９７８年～１９９４年间我院共行４６９例尸体肾移植，其中４例发生了恶性肿瘤，发生率０．８５％。肿瘤分别为鼻咽癌，胰头癌，白血病和Ｋａｐｏｓｉ＇ｓ肉瘤。此４例患者移植时年龄２６～４８岁。从肾移植至发生恶性肿瘤的间隔时间为２．５～６９个月，平均３６．６个月。其免疫抑制剂除１例为硫唑嘌呤加强的松外，余３例均为硫唑嘌呤、环孢素Ａ和强的松三联治疗。３例已死亡，死亡时移植肾功能正常，１例至今无瘤存活已达１年。建议对长期存活的肾移植受者应严密观察其肿瘤的发生。     

Renal diagnosis of chronic hemodialysis patients with urinary tract transitional cell carcinoma in Taiwan

BACKGROUND: Transitional cell carcinoma (TCC) is the most common malignancy in dialysis patients of Taiwan. The reason for such a high incidence of TCC is undetermined. The correlation between the underlying renal disease and the development of TCC was investigated. METHODS: The authors retrospectively reviewed the clinical data and outcome of 1537 chronic hemodialysis (HD) patients from 1993 to 2002. The incidence of TCC was computed. The Cox regression method was used to analyze the role of potential risk factors. RESULTS: After a mean dialysis duration of 46.5 months, 26 (1.69%) patients with TCC were diagnosed. The standardized incidence ratio (SIR) of TCC was 48.2 as compared with the general population and the SIR of TCC seemed higher in women (65.1) and in the age group 50 to 54 years (173.6). Of them, most cases showed no definite etiology. All these cases showed bilateral contracted kidneys. Nonnephrotic proteinuria was found in all cases and trace glucosuria was found in 17 (65%). Painless gross hematuria was the cardinal symptom and distant metastasis was rare. Also, TCC in upper urinary tracts were common and found in 14 (54%) of patients. Age at the time of dialysis, female sex, compound analgesic use, and Chinese herb use had statistical significance as risk factors (P < .05). CONCLUSIONS: Chronic HD patients have a high risk of TCC in Taiwan, especially in female and middle-aged patients. The study indicated that chronic tubulointerstitial nephritis (CTIN) is the most likely underlying renal disease in HD patients with TCC, a high percentage of the CTIN related to the usage of Chinese herbs or compound analgesics may contribute to the development of TCC, whereas diabetes or chronic glomerulonephritis play only a minor role.     

Effects of cyclosporine on human B-cell lymphoma development in vivo.

Cyclosporine (CsA) is a potent immunosuppressive agent primarily affecting T-lymphocyte function. Patients receive CsA following organ transplantation to prevent rejection. These patients are at high risk for developing Epstein-Barr virus (EBV)-induced lymphoproliferative disease (LPD) or B-cell lymphoma (BCL). Severe Combined Immunodeficient (SCID) mice reconstituted with human peripheral blood leukocytes (PBL) develop fatal B-cell lymphomas of human origin following latent or active infection with EBV. This model was utilized to determine the role of CsA in the development of human BCL. SCID mice were reconstituted with PBL, latently or actively infected with EBV, and treated with CsA. Following active EBV infection, mice developed human BCL with or without CsA treatment. In contrast, treatment with CsA prevented the development of BCL in mice latently infected with EBV. This suggests a T-cell interaction with latently infected B-cells which is perturbed by CsA. Further understanding of this interaction and the occurrence of human BCL may allow the development of strategies to prevent, detect, or treat malignancies associated with immunosuppression.     

The surgical management of recurrent urological malignancies after primary ablative therapy

This literature review highlights the surgical management of recurrent urological malignancies after primary ablative therapy. In particular, recurrent nonseminomatous germ cell tumours (NSGCT) post-chemotherapy, recurrent bladder cancer post-cystectomy, loco-regional recurrence of prostate cancer after radiotherapy, and loco-regional recurrence of renal cell carcinoma after radical nephrectomy. The indications, operative technique, complications and outcomes of each malignancy are discussed.     

Intracranial metastasis from primary transitional cell carcinoma of female urethra: case report &; review of the literature

Background  

Transitional cell carcinoma (TCC) of the female urethra is a rare urological malignancy, and intracranial metastasis of this cancer has not yet been reported in the literature. This review is intended to present a case of multiple intracranial metastasis in a female patient with a remote history of primary urethral TCC.     

Lung cancer as a second primary.

An unusually high association of other primary cancers (9.7%) was found during the analysis of 403 consecutive cases of carcinoma of the lung diagnosed at DGMC between 1960 and 1975. Incidence by stage included 17.3% for Stage I (75 cases) and 16.9% for Stage II (59 cases). Median survival by stage was not adversely affected by the associated malignancy. Incidence by histologic type was 15.6% for adenocarcinoma (132 cases), 7.7% for epidermoid (130 cases), 1.5% for oat (small cell) (67 cases), 12.5% for large cell (40 cases) and 11.8% for undifferentiated anaplastic type (34 cases). Of 31 cases of Stage I adenocarcinoma, 9 (29%) had second malignancies. Both adenocarcinoma and epidermoid carcinoma exhibited decreasing association of second malignances with increasing stage of lung cancer. The head and neck region was the location of the nonlung malignancy in 22 cases and the GU system in 11 cases. Two cases each of colon carcinoma and basal cell skin carcinoma were found and there was one case each of carcinoma of the pancreas, lymphoma and melanoma. The diagnosis of lung cancer was made first in only 3 instances. The appearance of solitary nodules in patients with known malignancy should receive strong consideration for vigorous diagnostic and therapeutic procedures. Future studies should consider carcinogenic stimuli that may be common etiologic factors in both malignancies.