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 radiotherapy is usually based on the Cincinnati Registry.
To systematically review all available evidence on the risk of cancer recurrence in end-stage renal disease patients with a history of urological cancer.
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.
Thirty-two retrospective studies enrolling 2519 patients (1733 dialysed, 786 radiotherapy) 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.
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.
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.
European urology. 2017 Aug 09 [Epub ahead of print]
Romain Boissier, Vital Hevia, Harman Max Bruins, Klemens Budde, Arnaldo Figueiredo, Enrique Lledó-García, Jonathon Olsburgh, Heinz Regele, Claire Fraser Taylor, Rhana Hassan Zakri, Cathy Yuhong Yuan, Alberto Breda
Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France., Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain., Department of Urology, Radboudumc, Nijmegen, The Netherlands., Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany., Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal., Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, England, UK., Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Department of Urology and Renal Transplantation St George's Hospital, London, England, UK., Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada., Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain. Electronic address: .