前列腺癌与实体器官移植：患者管理与结局

Prostate cancer and solid organ transplantation: patient management and outcomes

BJU INTERNATIONAL

影响因子:4.4

分区:医学2区 / 泌尿学与肾脏学2区

发表日期:2025 Feb

作者: Alon Lazarovich, Tanya W Kristof, Shavano Steadman, Aaron S Dahmen, Michelle A Josephson, Rolf Barth, Todd M Morgan, Marc-Olivier Timsit, Scott Eggener

DOI: 10.1111/bju.16558

摘要

旨在分析在器官移植前后诊断为前列腺癌的患者的管理与结局，鉴于器官移植及相关免疫抑制对前列腺癌发生率、发展及死亡率的影响仍是临床研究的热点和不确定性。本研究回顾性分析了来自两个三级医院的患者数据，这些患者接受了实体器官移植，且在移植前后被诊断为前列腺癌。收集的资料包括人口学信息和临床资料。研究队列包括110例患者，其前列腺癌诊断年龄的中位数（四分位间距IQR）为62（56.6-67.2）岁，移植年龄的中位数为58.6（52.7-65.3）岁。肾脏移植为最常见（54%）。前列腺癌诊断时的前列腺特异性抗原（PSA）中位数为6.2（4.5-10）ng/mL，依据美国泌尿学会风险分组：低风险36%，中等风险50%，高风险14%。其中45例（41%）在移植前被诊断为前列腺癌。治疗方式包括根治性前列腺切除术（RP；62%）、前列腺放疗（RT；13%）和积极监测（AS；18%）。在从诊断起的中位随访期为5.8（2.5-10）年内，1例（2%）患者发生转移性疾病。其余65例（59%）在移植后被诊断为前列腺癌，管理包括AS（29%）、RT（45%）和RP（15%）。随访中位期为5.3（1-8.4）年，3例（5%）发生转移性疾病，无前列腺癌相关死亡。局部前列腺癌的诊断不应成为拒绝实体器官移植的理由，移植的存在似乎不会显著增加前列腺癌的进展风险。

Abstract

To analyse the management and outcomes of individuals diagnosed with prostate cancer either before or after organ transplantation, as the impact of organ transplantation and associated immunosuppression on the incidence, progression, and mortality of prostate cancer remains an area of substantial clinical interest and uncertainty.We conducted a retrospective analysis of patients from two tertiary care centres who had solid organ transplantation and were diagnosed with prostate cancer before or after organ transplantation. Data collected included demographics and clinical information.The cohort consisted of 110 patients with a median (interquartile range [IQR]) age at prostate cancer diagnosis of 62 (56.6-67.2) years and a median (IQR) age at transplantation of 58.6 (52.7-65.3) years. Renal transplantation was the most common (54%). The median (IQR) prostate-specific antigen concentration at prostate cancer diagnosis was 6.2 (4.5-10) ng/mL, and the distribution of American Urological Association risk groups was: low risk, 36%; intermediate risk, 50%; and high risk, 14%. In all, 45 (41%) patients were diagnosed with prostate cancer prior to transplantation. Management included radical prostatectomy (RP; 62%), prostate radiotherapy (RT; 13%), and active surveillance (AS; 18%). During a median (IQR) follow-up of 5.8 (2.5-10) years from prostate cancer diagnosis, one (2%) patient developed metastatic disease. In all, 65 (59%) patients were diagnosed with prostate cancer subsequent to organ transplantation. Management included AS (29%), RT (45%), and RP (15%). During a median (IQR) follow-up of 5.3 (1-8.4) years, three patients (5%) developed metastatic disease. There were no deaths from prostate cancer.A diagnosis of localised prostate cancer should not preclude solid organ transplantation, and the presence of a transplant does not appear to substantially impact risk of prostate cancer progression.