Renal cell carcinoma (RCC) is the most prevalent solid organ malignancy among kidney transplant recipients, demonstrating substantially higher incidence rates compared to those in the general population. Although RCC is most commonly diagnosed in native kidneys, its development in transplanted kidneys has an infrequent occurrence. The use of immunosuppressive therapies, pre-existing chronic kidney disease and the unique anatomical characteristics of transplanted kidneys represent considerable therapeutic challenges in managing RCC within this patient cohort. Open radical transplantectomy plays a crucial role in curative treatment for localized RCC, whereas nephron-sparing surgery (NSS), in selected cases, can provide similar oncologic benefits while preserving allograft function. Recently, laparoscopic and robotic surgical procedures have demonstrated favorable outcomes as viable alternatives to conventional open surgery. Furthermore, ablative therapies like radiofrequency ablation and cryoablation can be considered therapeutic alternatives for small renal masses, offering the benefit of preserving allograft function, especially in high-risk surgical candidates. Limited data exist regarding the management of metastatic RCC in transplant recipients. Surgery, withdrawal of immunosuppression and systemic adjuvant therapy could be considered. Management of RCC in transplanted kidneys requires a multidisciplinary approach considering patient-specific characteristics, tumor features and the developing landscape of both surgical and non-surgical options. Further research is needed to refine therapeutic strategies in order to achieve optimal oncological outcomes while preserving allograft function.
肾细胞癌是肾移植受者中最常见的实体器官恶性肿瘤，其发病率显著高于普通人群。尽管肾细胞癌最常发生于自体肾脏，但在移植肾中发生的情况较为罕见。免疫抑制剂的使用、既存的慢性肾脏疾病以及移植肾独特的解剖学特征，使得该患者群体的肾细胞癌治疗面临重大挑战。开放性根治性移植肾切除术对于局限性肾细胞癌的治疗至关重要，而在特定病例中，保留肾单位手术可获得相似的肿瘤学疗效，同时保留移植肾功能。近年来，腹腔镜和机器人手术作为传统开放手术的可行替代方案，已显示出良好的治疗效果。此外，对于小型肾肿瘤，射频消融和冷冻消融等消融疗法可作为治疗选择，尤其对于手术高风险患者，具有保留移植肾功能的优势。关于移植受者转移性肾细胞癌的治疗数据有限，可考虑手术、停用免疫抑制剂及全身辅助治疗。移植肾肾细胞癌的管理需要多学科协作，综合考虑患者个体特征、肿瘤特性以及不断发展的手术与非手术治疗方案。未来需要进一步研究以优化治疗策略，在实现最佳肿瘤学疗效的同时，尽可能保留移植肾功能。
Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review
肿瘤(癌症)患者之家