104 148
Five-year recurrence rates for transplantation and
dialysed patients were 4.2
–
29% versus 24
–
57%, respectively.
Five-year cancer-specific survival rates and overall survival
were 86
–
98% and 43
–
88%, respectively, for patients who
remained on dialysis. Cancer-specific and overall survival
rates were not reported for transplanted patients.
3.3.4.
Testicular cancer
Three studies evaluated patients suffering from TC
( Table 8)
[4,8]. The 5-yr recurrence rate was 5%. The waiting period
before transplantation was not defined. Histology and
grade were specified only in two case reports: stage I
seminoma and teratoma. Cancer-specific and overall
survivals of 100% at 1
–
5 yr were reported in the two case
reports.
3.4.
RoB and confounding
The RoB and confounding was relevant, in particular in the
light of the generally low level of evidence studies
( Fig. 2).
The type of urological malignancy and the risk of recurrence
were taken into account in most of the studies. The duration
of the tumour-free period to transplantation and the
confirmation of a tumour-free status prior to transplanta-
tion were relevant only for the studies with an intervention
arm (transplantation).2
4.
Conclusions
4.1.
Principal findings
For RCC, the risk of recurrence was similar between
transplantation and dialysis. Stage, grade, histological
subtype, and solid/cystic component of the tumour were
the main prognostic factors for recurrence.
For PC, data were too scarce to reach a conclusion on the
impact of transplantation on the risk of recurrence because
the majority of the included studies were noncomparative
and involved only transplanted patients. Except in the study
of Woodle et al
[9], which is the last update of the Cincinnati
Registry, studies included mainly PC with favourable
prognosis: low stage, low grade, and low recurrence rates
consistent with nomograms (D
’
Amico, Partin, Kattan,
Memorial Sloan Kettering Cancer Center)
[9].
For urothelial carcinoma, the studies mainly included
UUTUC in the context of aristolochic acid nephropathy. In
this specific situation, the rate of synchronous bilateral
tumour was 10
–
16% and the rate of contralateral recurrence
was 31
–
39%. Data on bladder urothelial carcinoma and TC
were scarce.
For TC, one case report highlighted the possibility of late
recurrence (2.3 yr) even for a stage I seminoma.
4.2.
Findings in the context of existing evidence
Organ transplantation is a risk factor of cancer recurrence
especially for viral-induced cancers. However, this risk is
modulated by the type of cancer and the type of transplant
[10] .Table 8
–
Oncological outcomes of included patients with a history of testicular cancer: renal transplantation (I) versus renal replacement therapy (C)
Study
(1st author, yr)
Primary
management
Arms
(no. of
patients)
Cancer
recurrence
Cancer speci
fi
c
survival (time)
Overall
survival
(time)
Histological
outcomes
Follow-up
a(yr)
Free period to
transplantation
(yr)
Recommendations concerning
waiting period & prognostic
factors of recurrence, according to
authors of the included studies
5 yr
>
5 yr
Penn, 1997
[4]
NS
I (43)
NS
5%
NS
NS
NS
>
5
NS
Low risk of recurrence
Consider transplantation according
to clinical, radiological, and
biochemical criteria
Dean, 2005
[8]
1 Orchidectomy +
adjuvant
radiotherapy 20 Gy
I (1)
100% NS
100% (1
–
5 yr)
100% (1
–
5 yr)
Seminoma
stage I
4.3
2
Case-by-case discussion for waiting
period before transplantation
Transplantation did not interfere
with chemotherapy for recurrence at
2.3 yr
Juric, 2017
[47]
1 Orchidectomy
I (1)
0%
100%
100% (
>
5 yr)
100% (
>
5 yr)
Teratoma
3.6
20
Retroperitoneal recurrence 8 4 cm
(seminoma) treated by
lymphadenectomy + adjuvant
chemotherapy (cisplatine/etoposide).
Free from recurrence with 2 yr of
follow up.
C = control (dialysis); I = intervention; NR = not relevant; NS = not speci
fi
ed.
a
From cancer treatment to last news.
E U R O P E A N U R O L O GY 7 3 ( 2 0 18 ) 9 4
–
10 8
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