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Bašić D, Ignjatović I, Janković Veličković L, Veljković A. Molecular Characterization of Microrna Interference and Aristolochic Acid Intoxication Found in Upper Tract Urothelial Carcinoma in Patients with Balkan Endemic Nephropathy: A Systematic Review of the Current Literature. Balkan J Med Genet 2023; 25:105-111. [PMID: 37265966 PMCID: PMC10230835 DOI: 10.2478/bjmg-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The term "aristolochic acid nephropathy" (AAN) is used to include any form of toxic interstitial nephropathy that is caused either by ingestion of plants containing aristolochic acids (AA) or by the environmental contaminants in food such as in Balkan endemic nephropathy (BEN). Aristolochic acid (AA) intoxication is strongly associated with the development of upper tract urothelial carcinoma (UTUC); however, the underlying molecular mechanism remains to be defined. MicroRNAs (miRNA) regulate several biological processes, including cell proliferation, differentiation, and metabolism, acting as oncogenes or tumor suppressors. A unique miRNA expression profile suggested that miRNAs could function as regulators in UTUC developmental processes. This review aimed to summarize data available in the literature about underlying molecular mechanisms leading to the expression of miRNAs in AA-UTUC patients with BEN. Strong correlation in AA-UTUC has a distinctive gene alteration pattern, AL-DNA adducts, and a unique tumor protein (TP53) mutational spectrum AAG to TAG (A: T→T: A) transversion in codon 139 (Lys → Stop) of exon 5 activates the p53 tumor suppressor protein. Further, p53 protein is responsible not only for the expression of miRNAs but also acts as a target molecule for miRNAs and plays a crucial function in the AA-UTUC pathogenicity through activation of cyclin-dependent kinase (CyclinD1) and cyclin protein kinase 6(CDK6) to support cell cycle arrest. This study, proposed a molecular mechanism that represented a possible unique relationship between AA intoxication, miRNAs expression, and the progression of UTUC in patients with BEN.
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Affiliation(s)
- D Bašić
- Urology Clinic, University Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - I Ignjatović
- Urology Clinic, University Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Lj Janković Veličković
- Center for Pathology, University Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - A Veljković
- Department of Biochemistry, Faculty of Medicine, University of Niš, Niš, Serbia
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Manasa T, Meyyappan V, Sandeep P, Mylarappa P, Ramesh D, Jayakumar V, Penmetsa GK. Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and Objective: Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. Methods: All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. Results: A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. Conclusion: A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Level of evidence: Not applicable
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Affiliation(s)
- T Manasa
- Department of Urology, Ramaiah Medical College, India
| | | | | | | | - D Ramesh
- Department of Urology, Ramaiah Medical College, India
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Zhang Q, Ma R, Li Y, Lu M, Zhang H, Qiu M, Zhao L, Zhang S, Huang Y, Hou X, Ma L. Bilateral Nephroureterectomy Versus Unilateral Nephroureterectomy for Treating De Novo Upper Tract Urothelial Carcinoma After Renal Transplantation: A Comparison of Surgical and Oncological outcomes. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:11795549211035541. [PMID: 34393538 PMCID: PMC8358578 DOI: 10.1177/11795549211035541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
Background: There is currently no consensus on the optimal management of de novo unilateral upper tract urothelial carcinoma (UTUC) in renal transplant recipients. We aimed to compare the surgical and oncological outcomes of simultaneous bilateral radical nephroureterectomy (SBRNU) and unilateral radical nephroureterectomy (URNU) to determine the appropriate surgical method. Methods: Patients who developed de novo UTUC after renal transplantation and underwent surgical treatment at our center were included in the study. Outcomes were compared between the SBRNU group (underwent bilateral RNU within 3 months) and the URNU group using the Mann–Whitney U-test for continuous variables, Pearson’s chi-square test for categorical variables, and the log-rank test for survival data. Results: A total of 48 patients were identified, including 21 and 27 patients in the SBRNU and URNU groups, respectively. Comparison of perioperative data showed that the SBRNU group had a significantly longer operative time (P < .001) and hospital stay (P = .040) than the URNU group but no statistically significant difference in the blood loss (P = .171) and morbidity rate (P = .798). After a median follow-up of 65 months, the SBRNU group had a significantly longer disease-free survival (P = .009), longer cancer-specific survival (P = .032), marginally longer overall survival (P = .066), and similar intravesical recurrence-free survival (P = .274) than the URNU group. Conclusions: Our data suggest that SBRNU contributes to improved survival without significantly compromising the perioperative outcomes compared with URNU. SBRNU can be considered a feasible option for de novo UTUC after renal transplantation in specialized centers. Prospective studies should be conducted to further explore the best treatment options for this group of patients.
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Affiliation(s)
- Qiming Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Runzhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Youzhao Li
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Min Qiu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lei Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Jue JS, Alameddine M, Gonzále J, Cianci G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021; 45:427-438. [PMID: 34147429 DOI: 10.1016/j.acuroe.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Affiliation(s)
- J S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Alameddine
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gonzále
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Cianci
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Jue J, Alameddine M, González J, Ciancio G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021. [PMID: 33994047 DOI: 10.1016/j.acuro.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Kang YC, Chen MH, Lin CY, Lin CY, Chen YT. Aristolochic acid-associated urinary tract cancers: an updated meta-analysis of risk and oncologic outcomes after surgery and systematic review of molecular alterations observed in human studies. Ther Adv Drug Saf 2021; 12:2042098621997727. [PMID: 33815744 PMCID: PMC7989132 DOI: 10.1177/2042098621997727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The risk of primary aristolochic acid (AA)-associated urothelial carcinoma (AA-UC) has been summarized by a 2013-published meta-analysis. Given that additional evidence has been continuously reported by original studies, an updated meta-analysis is needed. Meanwhile, to complete the whole picture, a systematic review of molecular alterations observed in AA-urinary tract cancers (AA-UTC) was also performed. METHODS We searched PubMed, Embase and four Chinese databases up to October 2020. Observational studies comparing risk or oncologic outcomes of UTC between patients with and without AA exposure were eligible for systematic review and meta-analysis. Studies investigating molecular alterations in AA-UTC using human tissue samples were eligible for systematic review. RESULTS In total, 38 and 20 studies were included in the systematic review and meta-analysis, respectively. Exposure to AA led to an overall increased risks of primary UTC [UC and renal cell carcinoma (RCC)] (OR 6.085, 95% CI 3.045-12.160) and postoperatively recurrent UC (RR 1.831, 95% CI 1.528-2.194). Subgroup analysis of postoperative primary AA-upper tract UC (AA-UTUC) showed increased risks of bladder recurrence (adjusted RR 1.949, 95% CI 1.462-2.597) and contralateral UTUC recurrence (crude RR 3.760, 95% CI 2.225-6.353), worse overall survival (adjusted HR 2.025, 95% CI 1.432-2.865) and worse disease-specific survival (adjusted HR 3.061, 95% CI 1.190-7.872), but no effect on cancer-specific survival (adjusted HR 0.772, 95% CI 0.269-2.215). High mutation load with AA mutational signature presenting largely in the putative driver genes was observed in AA-UTUC. In contrast, AA mutational signature is rarely found in the mutated RCC driver genes and the mutation load in AA-RCC is low. Therefore, AA has different roles in the genesis of UTUC and RCC. CONCLUSIONS Implementing effective strategies to completely protect people from exposure to AA is urgently needed. Additionally, more effort should be made in identifying the precise carcinogenic mechanisms of AA to determine the future treatment strategies. PLAIN LANGUAGE SUMMARY Risk, recurrence and survival outcomes after surgery and molecular changes possibly involved in the genesis of aristolochic acid-associated urinary tract cancers Background: The association between aristolochic acid (AA) and primary urothelial carcinoma (UC) has been summarized by a 2013-published meta-analysis. Given that additional evidence has been reported in the past 7 years, an updated meta-analysis is needed. Meanwhile, to complete the whole picture, a systematic review of molecular changes possibly involved in AA-mediated urinary tract carcinogenesis was also performed. Methods: We searched PubMed, Embase and four Chinese databases for human studies up to October 2020. Studies comparing the risk of urinary tract cancer (UTC) between patients with and without AA exposure and studies investigating the molecular changes in AA-associated UTC (AA-UTC) using human tissue samples were eligible for inclusion. Thirty-eight studies were finally included. Results: The results showed that exposure to AA was associated with a 6-fold increased risk of primary UTC (UC and renal cell carcinoma, RCC) and a 1.8-fold increased risk of postoperatively recurrent UC. After studies reporting primary AA-upper tract UC (AA-UTUC) were analyzed, a 1.9-fold increased risk of bladder recurrence and a 3.8-fold increased risk of contralateral UTUC recurrence was observed. Additionally, exposure to AA worsened the postoperative survival of patients with UTUC by a 2-fold increased risk of overall death and a 3-fold increased risk of death from other diseases and recurrences. However, there was no effect on death due to cancer. Lastly, AA seemed to play different roles in the etiology of UTUC and RCC based on the observations of different mutation loads and different distributions of AA-induced mutations in AA-UTUC and AA-RCC samples. Conclusions: Implementing effective strategies to completely protect people from exposure to AA is urgently needed. Moreover, more effort should be made in identifying the precise carcinogenic mechanisms of AA-UTC to determine the future treatment strategies.
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Affiliation(s)
- Yu-Chan Kang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | - Ming-Hong Chen
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chih-Yun Lin
- Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung
| | - Yen-Ta Chen
- Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, No.123, Ta-Pei Road, Niao-Sung District, Kaohsiung City 83301
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Afshar-Mogaddam MR, Yadeghari A, Jouyban A. An Overview on Analytical Methods for Quantitative Determination of Aristolochic Acids. CURR ANAL CHEM 2020. [DOI: 10.2174/1573411014666180704124213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Aristolochic acids are chemically linked to nitrophenanthrene carboxylic acids
which are found in aristolochia plants. These compounds are intrinsically carcinogenic, while they
have been used in traditional medicine from a long time ago. Despite the beneficial effects of herbals
for treating some diseases, they possess some side effects.
Methods:
Therefore, the development of a sensitive and selective procedure for the determination of
these harmful components in various complicated samples is an important task for health systems and
drug authorities. In the past years, ultra-pressure liquid chromatography, high performance liquid
chromatography and capillary electrophoresis with different detection systems were used for determination
of aristolochic acids in various samples.
Results:
In this review, different analytical methods have been discussed in brief and applications of
them in diverse samples have been summarized.
Conclusion:
Different approaches are compared from point of sensitivity, selectivity, and extraction
efficiency.
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Affiliation(s)
| | - Adeleh Yadeghari
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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Kidney Graft Urothelial Carcinoma: Results From a Multicentric Retrospective National Study. Urology 2019; 135:101-105. [PMID: 31560916 DOI: 10.1016/j.urology.2019.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To calculate the incidence of renal graft urothelial carcinoma in renal transplant recipients in a national large retrospective cohort and to analyze circumstances of diagnosis, treatment and outcome. MATERIAL AND METHODS We conducted a national retrospective, multicenter study. Thirty two transplant centers were asked to report its cases of kidney graft tumors and the number of kidney transplantations performed since the beginning of their transplantation activity. RESULTS Between January 1988 and December 2018, 56,806 patients were transplanted in the 32 centers participating in this study. Among this cohort, 107 renal graft tumors (excluding lymphoma) were diagnosed among them 11 renal transplant recipients were diagnosed with an urothelial carcinoma in the kidney graft. The calculated incidence was 0.019%. The median patient age at the time of diagnosis was 56.7 years (49.8-60.9) and 51.4 years (47-55.7) at the time of transplantation. The median time between transplantation and diagnosis was 66.6 months (14.3-97). Before treatment, 3 patients had graft tumor biopsies revealing urothelial carcinomas, 3 patients had endoscopic retrograde uretero-pyelography showing lacunary images. Two patients had a diagnostic flexible ureteroscopy with biopsies. Total nephrectomy was performed in all cases. CONCLUSION Even though occurring in the context of immune suppression, most of these tumors seemed to have a relatively good prognosis. With regards to functional outcomes histological diagnosis should always be sought for before radical treatment of these tumors. Treatment should be a transplant nephrectomy including all the ureter with a bladder cuff to ensure optimal carcinologic control.
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Farkas ÁZ, Török S, Kovács JB, Piros L, Végső G, Kiss G, Korda D, Bibok A, Hartmann E, Deák ÁP, Doros A. Diagnosis and Management of a De Novo Urothelial Carcinoma in a Kidney Allograft: A Case Report. Transplant Proc 2019; 51:1281-1285. [PMID: 31101214 DOI: 10.1016/j.transproceed.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Following renal transplantation, the incidence of malignancies is 3-5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. CASE REPORT A 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. CONCLUSIONS Painless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.
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Affiliation(s)
- Ádám Z Farkas
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
| | - Szilárd Török
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - János Balázs Kovács
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - László Piros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Gyula Végső
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Gergely Kiss
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Dávid Korda
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - András Bibok
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Erika Hartmann
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Ákos P Deák
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Attila Doros
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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Bellini MI, Gopal JP, Hill P, Nicol D, Gibbons N. Urothelial carcinoma arising from the transplanted kidney: A single-center experience and literature review. Clin Transplant 2019; 33:e13559. [PMID: 30942927 DOI: 10.1111/ctr.13559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 01/07/2023]
Abstract
Urothelial carcinoma (UC) is a malignancy predominantly arising in the bladder. Upper tract UC (UUC) is uncommon, accounting only for 5-10% of the cases. High incidence of neoplasms is associated with immunosuppressive therapy; thus, UCs of the transplanted grafts often lead to a more aggressive treatment, in order to withdraw completely the immunosuppression. It significantly affects the patient quality of life, meaning return to dialysis, along with the worse life expectancy. We present our single-institution experience of this rare malignancy in two mid-age kidney transplant recipients, with UCs successfully treated with radical nephroureterectomy: G3 pT3 N0 + G3 pT1 N0 in the first patient and G3 pT2 N0 in the second one. We also review the previous literature focusing on stage of presentation and treatment for the affected kidney transplant patients.
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Affiliation(s)
| | | | - Peter Hill
- Renal Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - David Nicol
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research London, London, UK
| | - Norma Gibbons
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
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Yu J, Lee CU, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Sung HH. Incidences and oncological outcomes of urothelial carcinoma in kidney transplant recipients. Cancer Manag Res 2018; 11:157-166. [PMID: 30636892 PMCID: PMC6307682 DOI: 10.2147/cmar.s185796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We investigated to determine if there is an increased rate of urothelial carcinoma (UC) in kidney transplant (KT) recipients and to compare oncological outcomes of UC in KT recipients with non-KT patients. Patients and methods Among 2,186 patients who underwent KT in our institute, nine patients developed UC after KT in our center. Age-standardized rates (ASRs) were calculated to compare incidence rates of UC between KT patients and the general population. Additional five patients who underwent KT at other hospitals and received UC treatment at our center were included, thus a total of 14 KT patients were compared with non-KT patients in the aspect of the treatment outcomes of bladder cancer and upper urinary tract UC (UTUC) by using generalized estimating equation (GEE). Results The ASRs of bladder cancer and UTUC in KT recipients were 25.5 and 129.5 times higher than that of the general population. Although there was no difference in bladder cancer-specific survival rates (P-value 0.1186), however, progression rates of bladder cancer were significantly higher in KT recipients with a relative risk of 10.53 (P-value 0.0481). There was no significant difference in UTUC recurrence, progression, and specific survival rate (P-values 0.8915, 0.8806, and 0.8116, respectively). Conclusion Incidence of UC was much higher in KT recipients than the general population. Treatment outcomes for UC in KT recipients were not inferior to those of non-KT patients, except for the progression of bladder cancer. Special attention should be paid to screening and treatment of UC in KT recipients.
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Affiliation(s)
- Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,
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Heo J, Noh OK, Oh YT, Chun M, Kim L. Cancer risk after renal transplantation in South Korea: a nationwide population-based study. BMC Nephrol 2018; 19:311. [PMID: 30400877 PMCID: PMC6218979 DOI: 10.1186/s12882-018-1110-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023] Open
Abstract
Background This study aimed to evaluate patterns of posttransplant malignancies among renal transplant recipients (RTRs) in South Korea using nationwide data. Methods The nationwide cohort assessed in this study included RTRs from January 1, 2010, to December 31, 2014. We analyzed cancer incidence during the time course after renal transplantation. Additionally, we calculated standardized incidence ratios (SIRs) to evaluate the risk of malignancies in RTRs. Results A total of 1343 RTRs (871 males and 472 females, mean age 48.5 ± 11.6 years) were assessed. Among them, 104 (7.7%) developed malignancies after transplantation, most commonly in the thyroid cancer (23.1%). The SIR for all cancers was 3.54; particularly, the SIRs for renal cancer, myeloma, and non-Hodgkin lymphoma were 16.31, 24.02, and 28.64, respectively. Females showed a higher risk of malignancy than males (SIRs: 4.04 for women and 3.26 for men). The median interval between transplantation and malignancy diagnosis was 27.2 months (range 12.3–54.8 months). Conclusions RTRs in South Korea demonstrated a high risk of malignancy after transplantation compared with the general population. This indicates that close surveillance and routine screening for cancer in RTRs are needed.
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Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea. .,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea. .,Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea.
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, South Korea
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Hong YA, Hwang HS, Sul HJ, Kim SY, Chang YK. Transitional cell carcinoma involving graft kidney in a kidney transplant recipient: a case report. BMC Nephrol 2017; 18:299. [PMID: 28934936 PMCID: PMC5609046 DOI: 10.1186/s12882-017-0715-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Kidney transplantation (KT) is the treatment option for patients with end stage renal disease (ESRD) to prolong survival and improve quality of life. Although the use of potent immunosuppressive agents increases graft survival in kidney transplantation recipients (KTRs), it may lead to the development of malignancy, including transitional cell carcinoma (TCC). TCC developing in the pelvis of graft kidney is very rare in KTRs. Case Presentation A 40-year-old male visited hospital with complaints of nausea, vomiting and gross hematuria. Eleven years ago, he was diagnosed ESRD of unknown origin, and received a living related KT from his father 1 year later. Radiologic findings showed a huge polypoid mass in the pelvis of graft kidney with pelvo-calyceal dilation and a 3.3 cm-sized nodule in aortocaval chain and a 2.5 cm-sized nodule in right iliac chain as TCC stage IV. Sonography-guided percutaneous needle biopsy of pelvis mass in the graft kidney revealed a low grade urothelial cell carcinoma. Radical graft nephroureterectomy was performed and histopathological diagnosis confirmed as a low grade urothelial carcinoma of graft pelvis and ureter lumen, which invaded to perirenal fat and renal parenchyma with lymphovascular presence (T3Nx). The patient started with adjuvant concurrent chemo-radiation therapy and returned to regular hemodialysis. Conclusions We report a rare case of TCC in the pelvis of graft kidney with already advanced disease at diagnosis in a young KTR. For the early diagnosis of TCC in KTRs, exposure history to Chinese herb or analgesics should be investigated before KT and high risk population in KTRs should be tightly performed regular postoperative surveillance for TCC and considered of less calcineurin inhibitor-based immunosuppressant protocol.
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Affiliation(s)
- Yu Ah Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Hyeon Seok Hwang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Hae Joung Sul
- Department of Pathology, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Suk Young Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea
| | - Yoon Kyung Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
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14
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Polyomavirus Replication and Smoking Are Independent Risk Factors for Bladder Cancer After Renal Transplantation. Transplantation 2017; 101:1488-1494. [PMID: 27232933 DOI: 10.1097/tp.0000000000001260] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Solid organ transplant recipients are at increased risk for developing malignancies. Polyomaviruses (PV) have been historically associated with experimental tumor development and recently described in association with renourinary malignancies in transplant patients. The aim of this study was to investigate the relationship between PV replication and smoking, and the development of malignant neoplasms in kidney transplant recipients. METHODS A retrospective case-control study was conducted for PV replication in all kidney biopsies and urine cytologies performed between 1998 and 2014 from kidney transplant recipients at the University of Maryland Medical Center. Polyomavirus-positive patients (n = 943) were defined as having any of the following: a kidney biopsy with PV associated nephropathy, any urine cytology demonstrating "decoy" cells, and/or significant polyomavirus BK viremia. Polyomavirus-negative matched patients (n = 943) were defined as lacking any evidence of PV replication. The incidence of malignancy (excluding nonmelanoma skin tumors) was determined in these 1886 patients and correlated with demographic data and history of smoking. RESULTS There was a 7.9% incidence of malignant tumors after a mean posttransplant follow-up of 7.9 ± 5.4 years. Among all cancer subtypes, only bladder carcinoma was significantly associated with PV replication. By multivariate analysis, only PV replication and smoking independently increased the risk of bladder cancer, relative risk, 11.7 (P = 0.0013) and 5.6 (P = 0.0053), respectively. CONCLUSIONS The findings in the current study indicate that kidney transplant recipients with PV replication and smoking are at particular risk to develop bladder carcinomas and support the need for long-term cancer surveillance in these patients.
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15
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Gökçe Mİ, Kocaay AF, Aktürk S, Tüzüner A. Urothelial carcinoma of the allograft kidney developed in a renal transplant patient. Turk J Urol 2016; 42:213-5. [PMID: 27635300 DOI: 10.5152/tud.2016.97415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Renal transplantation is the best option in the treatment of end-stage renal disease However these patients are under the risk of developing malignancies particularly due to effects of immune supression. These malignancies tend to be more agressive compared to the general population. Here, we present a case of urothelial carcinoma develoing in the ureter of allograft kidney.
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Affiliation(s)
- Mehmet İlker Gökçe
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Akın Fırat Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Serkan Aktürk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Acar Tüzüner
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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16
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Shang D, Zheng T, Zhang J, Tian Y, Liu Y. Profiling of mRNA and long non-coding RNA of urothelial cancer in recipients after renal transplantation. Tumour Biol 2016; 37:12673-12684. [PMID: 27448299 DOI: 10.1007/s13277-016-5148-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/11/2016] [Indexed: 12/14/2022] Open
Abstract
The molecular mechanism and signal transduction pathways involved in urothelial cancer (UC) after renal transplantation (RTx) remain unknown. In this study, we investigated the profiling of messenger RNA (mRNA) and long non-coding RNA (lncRNA) in RTx recipients with UC. The mRNA and lncRNA of six pairs of UC and corresponding normal urothelial tissues in RTx recipients were profiled using Arraystar Human lncRNA Microarray V3.0, which is designed for the global profiling of 26,109 coding transcripts and 30,586 lncRNAs. Quantitative real-time PCR (qRT-PCR) was used to validate the differentially expressed mRNAs and lncRNAs. Molecular function classification and biological process classification for the differentially expressed mRNAs were analyzed with Gene Ontology. The key pathways that were associated with UC after RTx were analyzed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Compared to normal urothelial tissues, 1597 mRNAs were upregulated and 1032 mRNAs were downregulated in UC; 2107 lncRNAs were upregulated and 1794 lncRNAs were downregulated (greater than twofold). Further qRT-PCR analysis of mRNA and lncRNA expression showed well consistency with the data of microarray analysis. The expression of matrix metalloprotease (MMP)-3, MMP-10, MMP-12, and MMP-13 was significantly increased, while the expression of CD36 was decreased in UC after RTx. Co-expression analysis of lncRNAs and their nearby coding genes showed that lncRNAs may play critical roles in regulating nearby genes in the carcinogenesis of UC. Our results also suggest that peroxisome proliferator-activated receptor (PPAR) signaling may be involved in UC after RTx. Moreover, several cytokines and their receptors were also significantly upregulated in UC after RTx, suggesting that cytokines might be modulated and participated in the carcinogenesis of UC after RTx. We analyzed the potential molecular mechanism and pathways involved in the UC of RTx recipients. Our results revealed that several key regulatory pathways and lncRNAs play critical roles in the carcinogenesis of UC, and suggest that UC in RTx recipients may be more likely to invade and metastasis. However, the detailed functional analysis of these mechanisms should be further performed in the future.
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Affiliation(s)
- Donghao Shang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Tie Zheng
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, 100029, China
| | - Jian Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yuting Liu
- Department of Pathology, Capital Medical University, Beijing, 100069, China.
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17
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Treatment strategies for upper tract urothelial carcinoma (UTUC) of a solitary kidney: a single-institutional analysis of 61 cases. Int Urol Nephrol 2016; 48:1601-8. [DOI: 10.1007/s11255-016-1353-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/24/2016] [Indexed: 01/07/2023]
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18
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MicroRNA Profiling in Patients with Upper Tract Urothelial Carcinoma Associated with Balkan Endemic Nephropathy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7450461. [PMID: 27218105 PMCID: PMC4863087 DOI: 10.1155/2016/7450461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/02/2016] [Accepted: 04/04/2016] [Indexed: 02/08/2023]
Abstract
Balkan endemic nephropathy (BEN) is a disease that affects people that live in the alluvial plains along the tributaries of the Danube River in the Balkan region. BEN is a chronic tubulointerstitial disease with a slow progression to terminal renal failure and has strong association with upper tract urothelial carcinoma (UTUC). There are several hypotheses about the etiology of BEN, but only the toxic effect of aristolochic acid has been confirmed as a risk factor in the occurrence of the disease. Aberrantly expressed miRNAs have been shown to be associated with many types of cancers. A number of studies have investigated the expression of microRNAs in urothelial carcinoma, mainly on urothelial bladder cancer, and only a few have included patients with UTUC. Here we present the first study of microRNA profiling in UTUC tissues from patients with BEN (BEN-UTUC) and patients with UTUC from nonendemic Balkan regions (non-BEN-UTUC) in comparison to normal kidney tissues. We found 10 miRNAs that were differentially expressed in patients with BEN-UTUC and 15 miRNAs in patients with non-BEN-UTUC. miRNA signature determined in BEN-UTUC patients differs from the non-BEN-UTUC patients; only miR-205-5p was mutual in both groups.
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19
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Li ZK, Chen Y, Yang Y, Cheng K, Li ZP, Liu JY. Gemcitabine and Paclitaxel for Primary Bladder Carcinoma in Renal Transplant Recipients: A Case Report. Clin Genitourin Cancer 2016; 14:e423-5. [PMID: 27017467 DOI: 10.1016/j.clgc.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/14/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Zhi-Ke Li
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Ye Chen
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yu Yang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Ke Cheng
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhi-Ping Li
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Ji-Yan Liu
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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20
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Ranasinghe WKB, Suh N, Hughes PD. Survival Outcomes in Renal Transplant Recipients With Renal Cell Carcinoma or Transitional Cell Carcinoma From the ANZDATA Database. EXP CLIN TRANSPLANT 2015; 14:166-71. [PMID: 26669303 DOI: 10.6002/ect.2015.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our objective was to determine the incidence and outcomes of renal cell carcinoma and transitional cell carcinoma in recipients of renal allografts. MATERIALS AND METHODS We analyzed data from 2000 to 2012 in the Australia and New Zealand Dialysis and Transplant Registry, a binational population-based database, to identify the incidence and survival outcomes of renal transplant recipients with renal cell and transitional cell carcinoma. RESULTS Of the 8850 renal transplants, there were 60 new diagnoses of renal cancers posttransplant, with an overall cumulative incidence of 56 per 100,000 per year. Nine tumors were detected in the allograft, and 51 tumors (85%) were detected in the native kidney of the recipient. The median time of diagnosis from transplant was 6.6 years (range, 0.1-8.9 y). There were no cancer-specific deaths from allograft tumors; however, 17 cancer-specific deaths (14 from renal cell carcinoma and 3 from transitional cell carcinoma) occurred in patients with cancer in the native kidney. The 5-year and 10-year cancer-specific survival rates for renal cell carcinoma were 71.2% (95% confidence interval (CI): 57.0-84.0) and 58.5% (95% CI: 40.5-77.9), with 5-year and 10-year rates for transitional cell carcinoma of 50% (95% CI: 15.5-94.2) and 0%. CONCLUSIONS Renal cell carcinoma occurring in the native kidney comprised most of the tumors detected after renal transplant; however, transitional cell carcinoma occurred sooner after transplant and resulted in a lower cancer-specific survival rate. While it is important to screen those at risk of TCC prior and after renal transplant, the low incidence of TCC maybe too small to justify a benefit with routine screening, compared to RCCs.
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Affiliation(s)
- Weranja K B Ranasinghe
- From the Monash Medical Centre and the ANZDATA Registry, Adelaide, South Australia, Australia
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21
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Medani S, O'Kelly P, O'Brien KM, Mohan P, Magee C, Conlon P. Bladder cancer in renal allograft recipients: risk factors and outcomes. Transplant Proc 2015; 46:3466-73. [PMID: 25498074 DOI: 10.1016/j.transproceed.2014.06.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant recipients have an increased cancer risk owing to immunosuppression and oncogenic viral infections. We report on the incidence and types of bladder cancer in kidney transplant recipients in Ireland, describing possible additional risk factors and outcomes in these patients. METHODS We identified kidney transplant recipients diagnosed with de novo bladder cancer between January 1, 1994, and July 31, 2012, by integrating data from the Irish National Cancer Registry and National Renal Transplant Registry. We calculated the standardized incidence ratio (SIR) and examined patient and tumor characteristics and 1-year survival rate. RESULTS Fifteen patients were diagnosed with de novo bladder cancer during the study period, representing 0.48% of kidney transplant recipients. The SIR was 2.5 (95% CI, 1.4-4.2; P < .001). The mean interval between transplantation and diagnosis of bladder tumor was 8.6 years and mean age at time of diagnosis was 55.7 years. Sixty percent of patients were male. The tumor types were transitional cell carcinoma (9 patients), squamous cell carcinoma (3 patients), adenocarcinoma (1 patient), carcinoma in situ (1 patient), and diffuse large B-cell lymphoma (1 patient). Beside immunosuppression, risk factors associated with bladder cancer were urogenital disease (6 patients), cyclophosphamide exposure (2 patients), BK nephropathy (1 patient), analgesic nephropathy (1 patient), and extensive smoking (1 patient). Eight patients underwent radical cystectomy for invasive tumors, with resection of other pelvic organs in 7 patients. Mortality rate within the first year was 40%. CONCLUSION Bladder cancer occurred more commonly in kidney transplant recipients with a predominance of aggressive tumors and a high mortality. In patients with preexisting risk factors such as urologic abnormalities and cyclophosphamide exposure careful assessment before transplantation and vigilant monitoring posttransplantation with a low threshold for cystoscopy may improve outcomes.
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Affiliation(s)
- S Medani
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland.
| | - P O'Kelly
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | - P Mohan
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - C Magee
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Conlon
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
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22
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Poon SL, Huang MN, Choo Y, McPherson JR, Yu W, Heng HL, Gan A, Myint SS, Siew EY, Ler LD, Ng LG, Weng WH, Chuang CK, Yuen JSP, Pang ST, Tan P, Teh BT, Rozen SG. Mutation signatures implicate aristolochic acid in bladder cancer development. Genome Med 2015; 7:38. [PMID: 26015808 PMCID: PMC4443665 DOI: 10.1186/s13073-015-0161-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/02/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Aristolochic acid (AA) is a natural compound found in many plants of the Aristolochia genus, and these plants are widely used in traditional medicines for numerous conditions and for weight loss. Previous work has connected AA-mutagenesis to upper-tract urothelial cell carcinomas and hepatocellular carcinomas. We hypothesize that AA may also contribute to bladder cancer. METHODS Here, we investigated the involvement of AA-mutagenesis in bladder cancer by sequencing bladder tumor genomes from two patients with known exposure to AA. After detecting strong mutational signatures of AA exposure in these tumors, we exome-sequenced and analyzed an additional 11 bladder tumors and analyzed publicly available somatic mutation data from a further 336 bladder tumors. RESULTS The somatic mutations in the bladder tumors from the two patients with known AA exposure showed overwhelming AA signatures. We also detected evidence of AA exposure in 1 out of 11 bladder tumors from Singapore and in 3 out of 99 bladder tumors from China. In addition, 1 out of 194 bladder tumors from North America showed a pattern of mutations that might have resulted from exposure to an unknown mutagen with a heretofore undescribed pattern of A > T mutations. Besides the signature of AA exposure, the bladder tumors also showed the CpG > TpG and activated-APOBEC signatures, which have been previously reported in bladder cancer. CONCLUSIONS This study demonstrates the utility of inferring mutagenic exposures from somatic mutation spectra. Moreover, AA exposure in bladder cancer appears to be more pervasive in the East, where traditional herbal medicine is more widely used. More broadly, our results suggest that AA exposure is more extensive than previously thought both in terms of populations at risk and in terms of types of cancers involved. This appears to be an important public health issue that should be addressed by further investigation and by primary prevention through regulation and education. In addition to opportunities for primary prevention, knowledge of AA exposure would provide opportunities for secondary prevention in the form of intensified screening of patients with known or suspected AA exposure.
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Affiliation(s)
- Song Ling Poon
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Mi Ni Huang
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Centre for Computational Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Yang Choo
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Centre for Computational Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - John R McPherson
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Centre for Computational Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Willie Yu
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />National University of Singapore, Graduate School for Integrative Sciences and Engineering, 28 Medical Drive, Singapore, 117456 Singapore
| | - Hong Lee Heng
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Anna Gan
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Swe Swe Myint
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Ee Yan Siew
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Lian Dee Ler
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />National University of Singapore, Graduate School for Integrative Sciences and Engineering, 28 Medical Drive, Singapore, 117456 Singapore
| | - Lay Guat Ng
- />Department of Urology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Wen-Hui Weng
- />Department of Chemical Engineering and Biotechnology, Graduate Institute of Biotechnology, National Taipei University of Technology, 1, Section 3, Chung-hsiao East Road, Taipei, 10608 Taiwan
| | - Cheng-Keng Chuang
- />Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, School of Medicine, Chang Gung University, 5, Fusing Street, Gueishan Township, Taoyuan County 333 Taiwan
| | - John SP Yuen
- />Department of Urology, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - See-Tong Pang
- />Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, School of Medicine, Chang Gung University, 5, Fusing Street, Gueishan Township, Taoyuan County 333 Taiwan
| | - Patrick Tan
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Division of Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Cancer Science Institute of Singapore, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, Singapore, 117456 Singapore
- />Genome Institute of Singapore, 60 Biopolis Street Genome, Singapore, 138672 Singapore
| | - Bin Tean Teh
- />Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Cancer Science Institute of Singapore, National University of Singapore, Centre for Life Sciences, 28 Medical Drive, Singapore, 117456 Singapore
| | - Steven G Rozen
- />Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
- />Centre for Computational Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857 Singapore
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23
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Fang D, Xiong G, Li X, Kang Y, Zhang L, Zhao G, Chen X, Yao L, Zhang X, Yu W, Gong K, Song Y, He Q, He Z, Zhou L, Guo Y. Incidence, characteristics, treatment strategies, and oncologic outcomes of synchronous bilateral upper tract urothelial carcinoma in the Chinese population1These authors contribute equally. Urol Oncol 2015; 33:66.e1-11. [DOI: 10.1016/j.urolonc.2014.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/03/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022]
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BK virus-associated urothelial carcinoma of a ureter graft in a renal transplant recipient: a case report. Transplant Proc 2014; 46:616-9. [PMID: 24656027 DOI: 10.1016/j.transproceed.2013.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/20/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urothelial carcinomas of ureter grafts in renal transplant patients are rare. Here we report our experience with a case of BK virus-associated urothelial carcinoma in a ureter graft. CASE REPORT A 47-year-old man developed chronic renal failure secondary to diabetes mellitus and started maintenance hemodialysis in September 2007. Two months later, the patient received a renal transplant from his 70-year-old mother. The patient developed BK virus-associated nephropathy 1 year after transplantation and presented with a decline in renal function and hydronephrosis in the transplanted kidney 4 years 6 months after transplantation. Cystoscopy and retrograde pyelography revealed an irregular filling defect in the ureter graft. Cytologic diagnosis of his urine revealed a high-grade urothelial carcinoma. Computerized tomography showed a cT2 ureteral tumor and no involvement of other organs. The patient subsequently underwent a transplant nephroureterectomy with bladder cuff resection. Histopathologic findings revealed a high-grade urothelial carcinoma, pT2, in the ureter graft with SV40-positive staining. The patient was closely observed without adjuvant chemotherapy therapy and remained disease free 1 year after surgery. Renal transplant recipients with BK virus infection are at high risk of developing urologic malignancies. Close attention is necessary to diagnose post-transplantation urologica malignancies as early as possible.
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Zhang A, Shang D, Zhang J, Zhang L, Shi R, Fu F, Tian Y. A retrospective review of patients with urothelial cancer in 3,370 recipients after renal transplantation: a single-center experience. World J Urol 2014; 33:713-7. [DOI: 10.1007/s00345-014-1412-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022] Open
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Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge. BIOMED RESEARCH INTERNATIONAL 2014; 2014:989458. [PMID: 25177705 PMCID: PMC4142288 DOI: 10.1155/2014/989458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 01/07/2023]
Abstract
Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging could prove useful for the detection and staging of upper tract urothelial carcinomas in dialysis patients. Renal ultrasound can detect hydronephrosis caused by upper tract urothelial carcinomas in kidney transplant recipients but cannot visualize the carcinomas themselves. High detection rates for upper tract urothelial carcinomas in kidney transplant recipients have recently been demonstrated using computed tomography urography, which appears to be a promising tool. To detect carcinomas in dialysis patients and kidney transplant recipients as early as possible, regular screening in asymptomatic patients and diagnostic work-up in symptomatic patients should be performed using a combination of urological and imaging methods. Careful assessment of subsequent recurrence within the contralateral upper urinary tract and the urinary bladder is necessary for dialysis patients and kidney transplant recipients with upper tract urothelial carcinomas.
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Chinese herbs containing aristolochic acid associated with renal failure and urothelial carcinoma: a review from epidemiologic observations to causal inference. BIOMED RESEARCH INTERNATIONAL 2014; 2014:569325. [PMID: 25431765 PMCID: PMC4241283 DOI: 10.1155/2014/569325] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/08/2014] [Indexed: 02/03/2023]
Abstract
Herbal remedies containing aristolochic acid (AA) have been designated to be a strong carcinogen. This review summarizes major epidemiologic evidence to argue for the causal association between AA exposure and urothelial carcinoma as well as nephropathy. The exposure scenarios include the following: Belgian women taking slimming pills containing single material Guang Fang Ji, consumptions of mixtures of Chinese herbal products in the general population and patients with chronic renal failure in Taiwan, occupational exposure in Chinese herbalists, and food contamination in farming villages in valleys of the Danube River. Such an association is corroborated by detecting specific DNA adducts in the tumor tissue removed from affected patients. Preventive actions of banning such use and education to the healthcare professionals and public are necessary for the safety of herbal remedies.
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Risk factors and treatment outcomes of new contralateral upper urinary urothelial carcinoma after nephroureterectomy: the experiences of a large Chinese center. J Cancer Res Clin Oncol 2014; 140:477-85. [PMID: 24469253 DOI: 10.1007/s00432-014-1585-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the risk factors and treatment outcomes of contralateral new upper tract urothelial carcinoma (UTUC) after nephroureterectomy in a large single-center cohort of UTUC patients. METHODS A retrospective analysis of the clinicopathological data of 509 consecutive patients treated by nephroureterectomy from 2000 to 2010 at a high-volume center in China was conducted. RESULTS Thirty-five patients (6.9%) were found to develop contralateral UTUC. Gross hematuria was a common symptom, and aristolochic acid (AA) containing Chinese herbs was identified as an underlying cause. In multivariate analysis, renal transplant recipients (HR = 16.507) and preoperative renal insufficiency (HR = 2.523) were independent risk factors. No correlation was found in the clinical and pathological characteristics of primary and subsequent contralateral UTUC. A second round of nephroureterectomy should be performed on renal transplant patients, whereas patients who are older, exhibit relatively better renal function, and have tumors that are single, located in the ureter and small size could be treated with nephron-sparing surgery. No survival difference was detected between the two treatment groups, and developing contralateral UTUC was not associated with worse survival. CONCLUSION Contralateral UTUC is comparatively rare, and gross hematuria is a common symptom. Renal transplant history and renal insufficiency are independent risk factors, and prophylactic contralateral nephroureterectomy is considered for uremic UTUC patients with proper renal replacement treatment or renal transplant recipients. These features are likely related to the mechanisms of multifocality of UTUC, and the potential correlation with AA remains to be elucidated. Tumor characteristics and renal function are informative for the decisions concerning surgical options for contralateral UTUC.
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Contralateral Nephroureterectomy for Renal Transplant Recipients With Unilateral Upper Urinary Tract Transitional Cell Carcinoma: A Report of 12 Cases. Transplant Proc 2013; 45:2203-6. [DOI: 10.1016/j.transproceed.2012.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/16/2012] [Indexed: 12/29/2022]
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Distinguishing characteristics of urothelial carcinoma in kidney transplant recipients between China and Western countries. Transplant Proc 2013; 45:2197-202. [PMID: 23747184 DOI: 10.1016/j.transproceed.2012.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/09/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify significant distinctive characteristics of urothelial carcinoma (UC) in kidney transplant recipients between China and Western countries and investigate probable tumor screening and treatment factors contributing to these differences. METHODS Renal transplant recipients from 1998 to 2011 in our institution diagnosed with UC were included in this study. Our data on tumor incidence, clinical characteristics, and outcomes were compared with literature reports. RESULTS Among 2572 renal transplant recipients identified, 24 (0.93%) experienced UC, including 10 men and 14 women of overall mean age of 49.3 ± 11.6 years at transplantation and 53.5 ± 9.5 years at tumor detection. The Chinese traditional herbal intake mainly focused on 2 preparations: Aristolochic acid and rhubarb (the latter was mainly used in patients with chronic renal impairment) in 20 people. There were 21 (87.5%) cases of upper (UTUC) 5 cases of bilateral, and 13 cases of multifocal urinary tract urothelial carcinoma. Four subjects died owing to tumor progression at 4-63 months postoperatively. CONCLUSIONS UC in renal transplant recipients shared notable characteristics in China with widespread herb intake: UTUC predominance; multifocal and bilateral organ involvement; high rates of recurrence, progression, and dissemination, in contrast with bladder tumor dominance in Western countries. As a consequence, we suggest that bilateral nephroureterectomy should be performed prophylactically in high-risk patients, especially those with a long history of Chinese herb intake. The relationship of rhubarb consumption to UC in renal transplant recipients should be noted and evaluated.
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Transitional cell carcinoma of the kidney graft: an extremely uncommon presentation of tumor in renal transplant recipients. Case Rep Transplant 2013; 2013:196528. [PMID: 23781380 PMCID: PMC3677624 DOI: 10.1155/2013/196528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/08/2013] [Indexed: 01/19/2023] Open
Abstract
Purpose. Transitional cell carcinoma (TCC) affecting the graft after renal transplantation is a very infrequent way of presentation of this tumor. Our aim is to present our single institution experience with 2 cases, as well as to perform a review of the literature about this tumor after the transplant. Materials and Methods. TCC of the graft developed in 2 of 1365 patients from 1977 to 2010, both cases in women. Data were analyzed for incidence, clinical presentation, treatment, and outcomes. Results. Both cases occurred in 2 mid-age women and resulted to be high grade and locally advanced TCCs, representing an incidence of 0,14% (2/1365). Clinical presentation was urinary obstruction for the first case and incidental ultrasound finding for the second. Preoperative staging was made with CT, cytology, pyelography, ureterorenoscopy, and biopsy. Treatment performed was nephroureterectomy of the graft with bladder cuff and regional lymphadenectomy. Pathological examination showed in both cases a locally advanced and high grade urothelial carcinoma of the pelvis allograft. After 24 and 14 months of followup, both patients are disease free. Conclusions. TCC of the kidney graft is an infrequent tumor that has only been reported in a few cases in the literature. It usually appears at a lower age, more often locally advanced, and with poor differentiation. A multidisciplinary approach to treatment should be required in these cases.
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Kim EJY, Chen Y, Huang JQ, Li KM, Razmovski-Naumovski V, Poon J, Chan K, Roufogalis BD, McLachlan AJ, Mo SL, Yang D, Yao M, Liu Z, Liu J, Li GQ. Evidence-based toxicity evaluation and scheduling of Chinese herbal medicines. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:40-61. [PMID: 23286904 DOI: 10.1016/j.jep.2012.12.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 05/19/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE While there is an increasing number of toxicity report cases and toxicological studies on Chinese herbal medicines, the guidelines for toxicity evaluation and scheduling of Chinese herbal medicines are lacking. AIM The aim of this study was to review the current literature on potentially toxic Chinese herbal medicines, and to develop a scheduling platform which will inform an evidence-based regulatory framework for these medicines in the community. MATERIALS AND METHODS The Australian and Chinese regulations were used as a starting point to compile a list of potentially toxic herbs. Systematic literature searches of botanical and pharmaceutical Latin name, English and Chinese names and suspected toxic chemicals were conducted on Medline, PubMed and Chinese CNKI databases. RESULTS Seventy-four Chinese herbal medicines were identified and five of them were selected for detailed study. Preclinical and clinical data were summarised at six levels. Based on the evaluation criteria, which included risk-benefit analysis, severity of toxic effects and clinical and preclinical data, four regulatory classes were proposed: Prohibited for medicinal usage, which are those with high toxicity and can lead to injury or death, e.g., aristolochia; Restricted for medicinal usage, e.g., aconite, asarum, and ephedra; Required warning label, e.g., coltsfoot; and Over-the-counter herbs for those herbs with a safe toxicity profile. CONCLUSION Chinese herbal medicines should be scheduled based on a set of evaluation criteria, to ensure their safe use and to satisfy the need for access to the herbs. The current Chinese and Australian regulation of Chinese herbal medicines should be updated to restrict the access of some potentially toxic herbs to Chinese medicine practitioners who are qualified through registration.
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Affiliation(s)
- Ellie J Y Kim
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia
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Wu F, Wang T. Risk assessment of upper tract urothelial carcinoma related to aristolochic acid. Cancer Epidemiol Biomarkers Prev 2013; 22:812-20. [PMID: 23462915 DOI: 10.1158/1055-9965.epi-12-1386] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aristolochic acid is a toxin found in plants of the genus Aristolochia, to which humans can be exposed either through certain Chinese herbal medicines or through inadvertent commingling with food crops. Our objective was to estimate cumulative exposures of aristolochic acid associated with increased risk of end-stage renal disease (ESRD), and to conduct a systematic review and meta-analysis on aristolochic acid-induced upper tract urothelial carcinoma (UUC). METHODS Using epidemiologic studies on aristolochic acid-related disease from multiple different regions of the world, a systematic review was conducted in which relative risks (RR), HRs, and ORs were derived or extracted directly, and a meta-analysis was conducted. One study was used to estimate a benchmark dose lower confidence limit (BMDL) for aristolochic acid-related ESRD. RESULTS Mean values for risk ratios, ORs, RRs, or HRs, of UUC caused by aristolochic acid ranged from 1 to 49. A meta-analysis of these studies resulted in a pooled OR of 5.97 [95% confidence interval (CI), 2.78-12.84] for this aristolochic acid-related cancer. The obtained BMDL for aristolochic acid-related ESRD was 0.42 g cumulative aristolochic acid exposure. CONCLUSIONS Aristolochic acid exposure is significantly associated with an increased risk of UUC, and there is a dose-dependent relationship between cumulative aristolochic acid exposure and ESRD risk. IMPACT Individuals who use certain Chinese herbal medicines may significantly increase their risk of developing UUC and/or ESRD, as would individuals who are inadvertently exposed to aristolochic acid through commingling of Aristolochia plants with harvested food crops.
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Affiliation(s)
- Felicia Wu
- Michigan State University, 469 Wilson Rd, East Lansing, MI 48824, USA.
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Cheung CY, Lam MF, Chu KH, Chow KM, Tsang KY, Yuen SK, Wong PN, Chan SK, Leung KT, Chan CK, Ho YW, Chau KF. Malignancies after kidney transplantation: Hong Kong renal registry. Am J Transplant 2012; 12:3039-46. [PMID: 22883513 DOI: 10.1111/j.1600-6143.2012.04209.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Manystudies have shown that kidney transplant recipients have a higher incidence of cancers when compared with general population. However, most data on the posttransplant malignancies (PTM) are derived from Western literature and large population-based studies are rare. There is also lack of information about the posttransplant cancer-specific mortality rate. We conducted a population-based study of 4895 kidney transplants between 1972 and 2011, with data from the Hong Kong Renal Registry. Patterns of cancer incidence and mortality in our kidney transplant recipients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. With 40 246 person-years of follow-up, 299 PTM was diagnosed. The SIR of all cancers was 2.94 (female 3.58 and male 2.58). Non-Hodgkin lymphoma (NHL), kidney, and bladder cancers had the highest SIRs. The overall SMR was 2.3 (female 3.4 and male 1.7) and the highest SMR was NHL. The patterns of PTM differ among countries. Increases in cancer incidence can now translate into similar increases in cancer mortality. NHL is important in our kidney transplant recipients. Strategies in cancer screening in selected patient groups are needed to improve transplant outcomes.
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Affiliation(s)
- C Y Cheung
- Renal Unit, Queen Elizabeth Hospital, Hong Kong, China.
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Wu JT, Wan FC, Gao ZL, Wang JM, Yang DD. Transperitoneal laparoscopic nephroureterectomy for native upper tract urothelial carcinoma in renal transplant recipients. World J Urol 2012; 31:135-9. [PMID: 22527671 DOI: 10.1007/s00345-012-0865-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/28/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To analyze the safety and clinical outcome of laparoscopic nephroureterectomy (LNUT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients. METHODS We conducted a retrospective analysis of 956 RT recipients from January 2003 to December 2010 to evaluate the benefit of LNUT for patients who were diagnosed with de novo UC after renal transplantation. RESULTS Women predominated (10/11, 91 %) in the 11 patients with upper tract UC who underwent LNUT. Five patients underwent LNUT ipsilateral to the transplanted kidney, 4 patients underwent contralateral LNUT, and 2 patients underwent bilateral LNUT. Nine were operated with LNUT combining resection of bladder cuff, 2 with right ureteral cancer underwent open ureterectomy with bladder cuff due to severe adhesions attached to the lesion. The mean surgical duration was 184.2 min (105-305), the mean blood loss was 182.3 ml (20-500), and the mean hospitalization time was 6.7 days (5-9). The mean levels of preoperative and postoperative serum creatinine were 0.99 mg/dl (0.78-1.16) and 1.01 mg/dl (0.89-1.18), respectively. No intraoperative complications occurred. One patient died of multiple metastases at 13 months after LNUT. The mean follow-up of the remaining 10 patients after diagnosis was 21.7 months (3-48). Two patients had recurrent bladder cancer and underwent transurethral resection of the tumor. Eight patients showed no evidence of disease during the follow-up. CONCLUSIONS LNUT is a safe and effective approach with low morbidity in transplant recipients, and this therapy provides less trauma, quicker recovery, and acceptable oncological outcomes.
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Affiliation(s)
- Ji-Tao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong Province, China
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Rogers A, Koo Ng J, Glendinning J, Rix D. The management of transitional cell carcinoma (TCC) in a European regional renal transplant population. BJU Int 2012; 110:E34-40. [DOI: 10.1111/j.1464-410x.2011.10777.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Yang HY, Wang JD, Lo TC, Chen PC. Increased risks of upper tract urothelial carcinoma in male and female chinese herbalists. J Formos Med Assoc 2011; 110:161-8. [PMID: 21497279 DOI: 10.1016/s0929-6646(11)60026-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/29/2009] [Accepted: 02/12/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND/PURPOSE It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed. METHODS We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan. RESULTS There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists. CONCLUSION The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity.
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Affiliation(s)
- Hsiao-Yu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
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Li WH, Chen YJ, Tseng WC, Lin MW, Chen TJ, Chu SY, Hwang CY, Chen CC, Lee DD, Chang YT, Wang WJ, Liu HN. Malignancies after renal transplantation in Taiwan: a nationwide population-based study. Nephrol Dial Transplant 2011; 27:833-9. [PMID: 21633099 DOI: 10.1093/ndt/gfr277] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Renal transplantation has been regarded as the treatment of choice for end-stage renal disease. Renal transplantation increases the risk of cancers due to long-term immunosuppression. The types of post-transplantation malignancies may vary among different geographic regions and ethnic populations. To date, large population-based studies of post-transplantation malignancies in Asian renal transplant recipients (RTRs) have rarely been reported. METHODS To investigate the patterns of post-transplantation malignancies in Chinese RTRs, we performed a nationwide population-based cohort study between 1997 and 2008 based on data from the National Health Insurance Database in Taiwan. Patterns of cancer incidence in RTRs were compared with those of the general population using standardized incidence ratios (SIRs). RESULTS Among the 4716 RTRs (2475 males and 2241 females; mean age 44.1 ± 12.4 years) and 22 556 person-years of observation, 320 post-transplant cancers were diagnosed. The SIR of all cancers was 3.75 (95% confidence interval 3.36-4.18). Women had a higher risk than men for the development of malignancies (SIR 5.04 for women and SIR 2.88 for men). Renal, bladder and liver cancers were the most common cancers, with SIRs of 44.29, 42.89 and 5.07, respectively. When stratified by age, RTRs of young age at transplant (<20 years) had the highest risk of post-transplantation malignancies. CONCLUSIONS This study demonstrates different patterns of malignancies after renal transplantation in Chinese RTRs, with higher incidences of kidney and bladder cancers. Physicians should be more vigilant in examining RTRs for post-transplantation malignancies especially in younger patients.
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Affiliation(s)
- Wei-Hsuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Transitional Cell Carcinoma of the Native Urinary Tract After Kidney Transplantation: Recommendations Following a Long-Term Retrospective Analysis. Am J Med Sci 2011; 341:478-83. [DOI: 10.1097/maj.0b013e31820a87f7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Urothelial cancers after renal transplantation. Int Urol Nephrol 2011; 43:681-6. [DOI: 10.1007/s11255-011-9907-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 02/01/2011] [Indexed: 01/20/2023]
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Ye J, Ma L, Huang Y, Hou X, Xiao C, Zhao L, Wang G, Hong K, Lu J. Retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney. Urology 2010; 76:1395-9. [PMID: 20430425 DOI: 10.1016/j.urology.2010.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/28/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We present preliminary experience of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney. METHODS Thirteen renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU between November 2005 and August 2008. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment, and the intact specimen was removed manually via the same incision. The cystostomy was generally not sutured. RESULTS The mean operation time was 264 minutes. The mean estimated blood loss was 256 mL. Three patients needed blood transfusion. No open conversion was required. Two patients experienced minor complications. Pathologic findings confirmed UUT-TCC in all patients with 8 of the pelvis and 7 of the ureter. Four were involved with bladder TCC. With the mean follow-up of 30 months, none of the patients developed retroperitoneal recurrence or distant metastasis, 2 of the 4 patients with bladder TCC had recurrence in the bladder, and 2 had contralateral UUT-TCC after the first unilateral nephroureterectomy. CONCLUSIONS RPLNU with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection might be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with acceptable oncological outcomes.
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Affiliation(s)
- Jianfei Ye
- Department of Urology, Peking University Third Hospital, Beijing, China
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Elkentaoui H, Robert G, Pasticier G, Bernhard JC, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H. Therapeutic Management of De Novo Urological Malignancy in Renal Transplant Recipients: The Experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology 2010; 75:126-32. [PMID: 19864001 DOI: 10.1016/j.urology.2009.06.106] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/10/2009] [Accepted: 06/26/2009] [Indexed: 12/11/2022]
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Wang J, Xing N, Zhang X, Yan Y, Zhang J, Li X, Zhang W, Guan D. Orthotopic ileal neobladder reconstruction in patients with recurring bladder cancer after renal transplantation--a report of two cases and a review of the literature. Clin Transplant 2009; 23:700-4. [PMID: 19486344 DOI: 10.1111/j.1399-0012.2009.00988.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Renal transplant recipients have a high risk of developing multiple and invasive urothelial tumors because of long-term immunosuppression and infections with oncogenic viruses in China. However, treatment of renal transplant recipients who developed invasive bladder tumor is challenging. We aimed to evaluate the efficacy and safety of orthotopic ileal neobladder reconstruction following radical cystectomy in renal transplant recipients. Orthotopic ileal neobladder reconstruction and preservation of the transplanted kidney were performed in two patients after one and 36 months of transplantation, respectively. One recipient was lacking a bladder because of prior cystectomy before the transplantation, and the other developed multiple and invasive bladder cancer after the transplantation. During the 14-month and seven-yr follow-up postoperation, no serious complications occurred except slight hydronephrosis in one patient. No rejection and graft dysfunction occurred in both patients with reduced dosage of immunosuppressants, and serum creatinine as a marker of renal function remained stable. Urinary continence was satisfactory during the day and night with voluntary voiding. Our experience showed that radical cystectomy and orthotopic ileal neobladder reconstruction in transplant patients with stable renal function is a safe and effective way to provide better quality of life, satisfactory urinary diversion and preservation of renal function simultaneously.
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Affiliation(s)
- Jianwen Wang
- The Division of Urology, Beijing Organ Transplantation Center, Beijing ChaoYang Hospital, Capital University of Medical Sciences, Beijing, China
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Yang HY, Wang JD, Lo TC, Chen PC. Increased mortality risk for cancers of the kidney and other urinary organs among Chinese herbalists. J Epidemiol 2009; 19:17-23. [PMID: 19164871 PMCID: PMC3924091 DOI: 10.2188/jea.je20080035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 08/22/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A national survey in Taiwan has shown that Chinese herbal therapy increases the risk of chronic kidney disease. However, it is unknown whether herbal therapy will increase the risk of urological cancers. The purpose of this study was to determine whether Chinese herbalists are at higher risk for urological cancers. METHODS We studied all Chinese herbalists in Taiwan that were registered in the Chinese Herbalist Labor Union between 1985 and 2000. We retrospectively followed their survival status and causes of death using the National Mortality Registry Database from 1985 to 2004. Standardized mortality ratios (SMRs) for urological cancers in herbalists were calculated and compared with those of the general population of Taiwan. RESULTS A total of 6548 Chinese herbalists were enrolled and 88,289 person-years were accrued during the observation period. After adjustment for age and sex, the SMR for urological cancers was significantly higher for Chinese herbalists than for the general population (SMR = 3.10; 95% CI: 1.41-5.87). When further stratified by location, the SMR for kidney cancer and other urinary organ cancers (SMR = 3.81; 95% CI: 1.39-8.28) except bladder cancer (SMR = 2.26; 95% CI: 0.47-6.59) were significantly higher for the Chinese herbalists. The SMR for chronic and unspecified nephritis, renal failure, and renal sclerosis were also significantly higher for herbalists (SMR = 2.40; 95% CI: 1.40-3.84). CONCLUSIONS Chinese herbalists have a significantly higher risk for urological cancers. This increased risk among herbalists highlights the urgent need for safety assessments of Chinese herbs.
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Affiliation(s)
- Hsiao-Yu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jung-Der Wang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Internal Medicine, and Department of Environmental and Occupational Medicine,
National Taiwan University Hospital, Taipei, Taiwan
| | | | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
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Chung SD. Transitional cell carcinoma in renal transplant recipients: a single center experience. Int J Urol 2009; 15:1024; author reply 1024. [PMID: 19138198 DOI: 10.1111/j.1442-2042.2008.02133.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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