Background/Objectives: Kidney transplantation is associated with an increased risk of renal cell carcinoma (RCC). This study aimed to evaluate the outcomes of de novo RCC in kidney transplant recipients (KTRs).Methods: We retrospectively identified 50 de novo RCC cases among 4012 KTRs transplanted from 2005 to 2024. Data on patient characteristics and outcomes were collected. Propensity score matching (PSM) compared 34 localized RCC cases in KTRs with 34 non-transplant RCC cases. The statistical analyses used Kaplan–Meier estimates, the log-rank test, and the Cox regression.Results: The RCC incidence was 0.64 per 1000 person-years, with a standardized incidence ratio of 4.40 (95% CI: 3.33–5.80). In the KTR cohort, clear cell RCC was present in 42%, and papillary RCC was present in 42%. RCC developed predominantly in native kidneys (92%). UICC stage I was present in 74%. The treatment for the non-metastatic RCC was nephrectomy in the majority of cases (91%). For the metastatic RCC, 71% received a tyrosine kinase inhibitor (TKI). In the KTR cohort, the 3- and 5-year overall survival (OS) rates were 85% and 72%, respectively, with a median OS of 199 months; the synchronous metastasized (M1) patients had a median OS of 14 months. Rejection, age, advanced UICC stage, higher pT stage, clinical positive lymph nodes, M1, and higher grade were significantly associated with poor OS. The 5-year OS (96% vs. 84%,p= 0.72) and MFS (92% vs. 93%,p= 0.61) were comparable in the PSM cohort between the KTRs and the non-KTRs in the localized RCC.Conclusions: KTRs have a higher risk of RCC and present at a localized stage with comparable OS rates to non-transplant RCC patients. Adverse tumor characteristics, including synchronous metastases, significantly affect the prognosis, highlighting the need for surveillance and individualized treatment, particularly for metastatic RCC.
**背景/目的：** 肾移植与肾细胞癌风险增加相关。本研究旨在评估肾移植受者中新发肾细胞癌的预后。 **方法：** 我们回顾性分析了2005年至2024年间4012例肾移植受者中的50例新发肾细胞癌病例。收集了患者特征和预后数据。采用倾向评分匹配法，将34例肾移植受者中的局限性肾细胞癌病例与34例非移植肾细胞癌病例进行比较。统计分析采用Kaplan-Meier估计、时序检验和Cox回归。 **结果：** 肾细胞癌发病率为每1000人年0.64例，标准化发病比为4.40（95% CI：3.33–5.80）。在肾移植受者队列中，透明细胞癌占42%，乳头状肾细胞癌占42%。肾细胞癌主要发生于自体肾脏（92%）。74%为UICC I期。对于非转移性肾细胞癌，大多数病例（91%）接受了肾切除术。对于转移性肾细胞癌，71%接受了酪氨酸激酶抑制剂治疗。在肾移植受者队列中，3年和5年总生存率分别为85%和72%，中位总生存期为199个月；同时性转移患者的平均总生存期为14个月。排斥反应、年龄、UICC分期较晚、pT分期较高、临床淋巴结阳性、M1分期以及分级较高与总生存率较差显著相关。在倾向评分匹配的局限性肾细胞癌队列中，肾移植受者与非肾移植受者的5年总生存率（96% vs. 84%，p=0.72）和无转移生存率（92% vs. 93%，p=0.61）相当。 **结论：** 肾移植受者发生肾细胞癌的风险更高，但通常处于局限性阶段，其总生存率与非移植肾细胞癌患者相当。不良的肿瘤特征，包括同时性转移，显著影响预后，这凸显了进行监测和实施个体化治疗的必要性，特别是对于转移性肾细胞癌。
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