腎臟移植族群原有腎腎水腫與上泌尿道泌尿上皮癌發生之研究

Native Hydronephrosis after Kidney Transplantation Relates to Upper Tract Urothelial Carcinoma: A Single Center Study

何承儒(Cheng-Ju Ho)

指導教授 ： 陳順郎

共同指導教授 ： 李宗賢(Tsung-Hsien Lee)

中山醫學大學/醫學院/醫學研究所/碩士(2021年)

https://doi.org/10.6834/csmu202100118

摘要

研究目的：上泌尿道泌尿上皮癌在台灣的腎臟移植受贈者中是最常於移植後發生的惡性腫瘤。本研究的目的在於了解腎臟移植受贈者中原有腎水腫與上泌尿道泌尿上皮癌間的相關性。
研究方法及資料：從2003年到2018年，收集在中山醫學大學附設醫院追蹤的1005例腎臟移植患者，其中67例日後被診斷為的上泌尿道泌尿上皮癌患者加入此回溯性研究。研究族群於研究中進一步可分為有無上泌尿道泌尿上皮癌兩個族群。多變量分析與Kaplan-Meier分析用於確認原有腎水腫與腎臟移植受贈後上泌尿道泌尿上皮癌間的相關性。
研究結果：本世代研究共有612位男性 (60.9%)與393位女性 (39.1%)，平均腎臟受贈年齡為48.2 ± 12.0歲。平均追蹤時長為118.6 ± 70.2個月，從腎臟移植到上泌尿道泌尿上皮癌發生的平均時間為7.53年。在上泌尿道泌尿上皮癌患者中，女性比例明顯高於男性 (73.1% : 26.9%, p <0.001)。與非上泌尿道泌尿上皮癌族群相比，上泌尿道泌尿上皮癌組的原有腎水腫發生率更高（分別為68.7%和4.8%，p <0.001）。在多變量分析中，原有腎水腫與女性皆與上泌尿道泌尿上皮癌有統計上顯著相關性，勝算比分別為35.32 (95％信類區間，17.99-69.36； p <0.001)與3.37 (95％信類區間，1.55-7.29； p =0.002)。腎臟移植受贈者所發生的上泌尿道泌尿上皮癌，在病理學上更具侵犯性且有雙側發生的傾向 (41.8%)。
結論與建議：台灣接受腎臟移植者的原有腎水腫與上泌尿道泌尿上皮癌發生有顯著相關。對於這類患者，原有腎水腫的有無可作為是否進行預防性腎臟輸尿管切除併膀胱袖口切除術的決定因子。

關鍵字

腎臟移植 ； 腎水腫 ； 上泌尿道 ； 泌尿上皮癌

並列摘要

Objective: Upper urinary tract urothelial carcinoma (UTUC) is the most common malignancy after kidney transplantation (KT) in Taiwan. The aim of this study is to investigate the association between native hydronephrosis and UTUC in post-KT patients.
Materials and Methods: From 2003 to 2018, we conducted a retrospective cohort study enrolled 1005 post-KT patients and 67 subsequently diagnosed with UTUC. We divide patients into two groups according to be with or without UTUC. Multivariate analysis and Kaplan-Meier plot are used to evaluate whether native hydronephrosis associates with post-KT UTUC.
Results: The total cohort consisted of 612 men (60.9%) and 393 women (39.1%) with a mean age 48.2 ± 12.0 at KT. The mean follow-up time was 118.6 ± 70.2 months, and mean time from KT to UTUC was 7.53 years. There was significant gender difference with female predominance in UTUC patients (73.1% versus 26.9%, p<0.001). Native hydronephrosis occurred more frequently in UTUC group (68.7% versus 4.8%, p<0.001). Multivariate analysis showed native hydronephrosis and female gender were significantly associated with UTUC with odds ratio of 35.32 (95% CI, 17.99-69.36; p<0.001) and 3.37 (95% CI, 1.55-7.29; p=0.002), respectively. UTUC in post-KT patients also showed aggressive pathological characteristic and tendency to bilateral lesion (41.8%).
Conclusions: Native hydronephrosis is significantly associated with post-KT UTUC patients in Taiwan. Native hydronephrosis may be a deciding factor for standard nephroureterectomy and bladder cuff excision in selected patients.

並列關鍵字

kidney transplantation ； hydronephrosis ； upper urinary tract ； urothelial carcinoma

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