After transplantation, approximately 10% of renal cell carcinomas are detected in graft kidneys. These tumors (gRCC) present surgeons with the difficulty of finding a treatment that guarantees both oncological clearance and maintenance of function. We conducted a systematic review and an individual patient data meta-analysis on the oncology, safety and functional outcomes of the available treatments for gRCC.
A systematic search was performed across MEDLINE, EMBASE, and Web of Science including any study reporting perioperative, functional and survival outcomes for patients undergoing graft nephrectomy (GN), partial nephrectomy (PN) or thermal ablation (TA) for gRCC. Quade's ANCOVA, Spearman Rho and Pearson Chi2, Kaplan-Meier, Log-rank and Standard Cox regression and other tests were used to compare treatments. Studies' quality was evaluated using a modified version of Newcastle Ottawa Scale.
129 studies (357 patients), were included. No differences between TA and PN were found in terms of safety, functional and oncological outcomes for T1a gRCCs. When applied to pT1b gRCC, PN showed no difference in complications, progression or cancer-specific deaths compared to smaller lesions; PN validity for pT2 gRCCs should be considered unverified due to lack of sufficient evidence. The efficacy and safety of PN or TA for multiple gRCC remain controversial. In case of non-functioning, large (T≥2), complicated or metastatic gRCCs, GN appears to be the most reasonable choice. Quality of evidence ranged from very low to moderate. Studies with large cohorts and longer follow-up are still needed to clarify oncological and functional differences.
PN and TA might be offered as a nephron-sparing treatment option in patients with T1a gRCC. There is no significant difference between these options and GN in terms of oncological outcomes and complications. PN and TA offer similar functional outcomes and graft preservation. PN for pT1b gRCC seems feasible and safe, but its validity should be considered unverified.
Minerva urology and nephrology. 2022 Sep 12 [Epub ahead of print]
Fabio Crocerossa, Riccardo Autorino, Ithaar Derweesh, Umberto Carbonara, Francesco Cantiello, Rocco Damiano, Jose Rubio-Briones, Morgan Roupret, Alberto Breda, Alessandro Volpe, M Carmen Mir, European Section of Urologic-Oncology (ESOU) of European Association of Urology (EAU)
Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA., Department of Urology, UCSD, San Diego, CA, USA., Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy., Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain., Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Paris, France., Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Division of Urology, Department of Translational Medicine, University of Eastern, Maggiore della Carità Hospital, Novara, Italy., Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain - .