Urologic oncology · 2026
Nonmuscle-invasive bladder cancer after solid organ transplantation: Clinical outcomes and recurrence patterns.
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Guzman Taeris, McSweeney Sean, Aydogdu Can, Diaz Gabriela, Baer Mikayla, Weight Christopher, Almassi Nima, Krishnamurthi Venkakesh, Eltemamy Mohamed, Campbell Rebecca, Sindhani Mohit, Bukavina Laura
Аннотация
BACKGROUND: Solid organ transplant recipients face an increased risk of bladder cancer and require lifelong immunosuppression, which may alter the natural history and treatment response of nonmuscle-invasive bladder cancer (NMIBC). Balancing cancer control with allograft preservation complicates clinical decision-making, yet outcome data in this population remain scarce.
METHODS: A retrospective study of transplant recipients diagnosed with NMIBC post-transplant was conducted. The index date was NMIBC diagnosis. NMIBC recurrence was the primary endpoint, with death before recurrence as a competing event. Recurrence-free survival was estimated using Kaplan-Meier methods, and cumulative incidence of recurrence and competing mortality using the Aalen-Johansen estimator. Cox models evaluated predictors of recurrence.
RESULTS: Fifty-nine transplant recipients met inclusion criteria (median age 68 years; 89.8% male), with high-risk disease present in 40/59 (67.8%). High-grade disease was present in 38/59 patients (64.4%), with T1 stage in 20/59 (33.9%) and concomitant carcinoma in situ in 13/59 (22.0%). Over a median follow-up of 37.4 months, 11/59 patients (18.6%) experienced recurrence at a median of 15.1 months, all among those receiving Bacillus Calmette-Guérin (BCG) induction. The 5-year cumulative incidence for recurrence was 20.4%, compared with 40.5% for competing mortality. Progression to advanced disease (≥pT2 and/or nodal involvement) occurred in 3/59 (5.1%) overall, predominantly within the high-grade subcohort. All-cause mortality was 36/59 (61.0%), with a bladder cancer-specific mortality of 5/59 (8.5%). In univariable models, tumor size >3 cm (HR 19.53, P = 0.005) and increasing age (HR 1.10, P = 0.066) were associated with recurrence. Granular information on specific non-BCG intravesical regimens was limited, precluding analysis of comparative efficacy among alternative agents in this population.
CONCLUSION: In this single-institution transplant cohort, competing mortality exceeded recurrence risk. Traditional prognostic factors like tumor size predicted recurrence, yet survival was driven by transplant-related comorbidities. These findings support the use of competing-risk methodologies for accurate outcome estimation and highlight the need for individualized, multidisciplinary management in this complex population.
METHODS: A retrospective study of transplant recipients diagnosed with NMIBC post-transplant was conducted. The index date was NMIBC diagnosis. NMIBC recurrence was the primary endpoint, with death before recurrence as a competing event. Recurrence-free survival was estimated using Kaplan-Meier methods, and cumulative incidence of recurrence and competing mortality using the Aalen-Johansen estimator. Cox models evaluated predictors of recurrence.
RESULTS: Fifty-nine transplant recipients met inclusion criteria (median age 68 years; 89.8% male), with high-risk disease present in 40/59 (67.8%). High-grade disease was present in 38/59 patients (64.4%), with T1 stage in 20/59 (33.9%) and concomitant carcinoma in situ in 13/59 (22.0%). Over a median follow-up of 37.4 months, 11/59 patients (18.6%) experienced recurrence at a median of 15.1 months, all among those receiving Bacillus Calmette-Guérin (BCG) induction. The 5-year cumulative incidence for recurrence was 20.4%, compared with 40.5% for competing mortality. Progression to advanced disease (≥pT2 and/or nodal involvement) occurred in 3/59 (5.1%) overall, predominantly within the high-grade subcohort. All-cause mortality was 36/59 (61.0%), with a bladder cancer-specific mortality of 5/59 (8.5%). In univariable models, tumor size >3 cm (HR 19.53, P = 0.005) and increasing age (HR 1.10, P = 0.066) were associated with recurrence. Granular information on specific non-BCG intravesical regimens was limited, precluding analysis of comparative efficacy among alternative agents in this population.
CONCLUSION: In this single-institution transplant cohort, competing mortality exceeded recurrence risk. Traditional prognostic factors like tumor size predicted recurrence, yet survival was driven by transplant-related comorbidities. These findings support the use of competing-risk methodologies for accurate outcome estimation and highlight the need for individualized, multidisciplinary management in this complex population.