摘要目的:探讨肾移植术后非肌层浸润性膀胱癌(non-muscle invasive bladder cancer，NMIBC)患者发生上尿路尿路上皮癌(upper tract urothelial carcinoma，UTUC)的特点及预后。方法:回顾性分析北京朝阳医院2014年1月至2022年6月收治的13例肾移植后首发为NMIBC后期接受上尿路切除手术患者的病例资料，男8例，女5例。年龄(56.1±11.5)岁。有吸烟史3例。既往有马兜铃酸服用史4例。因血尿就诊6例，因影像学检查提示膀胱肿瘤就诊7例。13例术前均行膀胱镜检查诊断为膀胱肿物，首发膀胱肿瘤数量单发9例，多发4例；肿瘤直径≤3 cm 9例，>3 cm 4例。13例均行经尿道膀胱肿瘤切除术(TURBt)，术后病理分级为低级别3例，高级别10例；T a期3例，T 1期10例。术后膀胱肿瘤复发5例。所有患者TURBt术后规律复查，6例于术后6~52个月影像学检查提示UTUC，其中肾积水2例，肾盂肿物1例，输尿管肿物3例，行患侧治疗性上尿路切除术；7例无UTUC影像学证据，行双侧预防性上尿路切除术。13例的术式均为腹腔镜肾输尿管切除+膀胱袖状切除术。采用Fisher精确检验比较肾移植术后NMIBC患者发生或未发生UTUC与各临床因素的关系。采用Kaplan-Meier法和log-rank检验进行生存分析，探讨发生UTUC对预后的影响。 结果:本研究13例中，术后病理诊断为UTUC(UTUC组)6例，无UTUC(非UTUC组)7例，两组的年龄( P＝0.10)、性别( P＝0.10)、吸烟史( P＝0.19)、马兜铃酸服用史( P＝0.99)、膀胱肿瘤数量( P＝0.56)、膀胱肿瘤分级( P＝0.19)、膀胱肿瘤分期( P＝0.19)、膀胱肿瘤复发( P＝0.10)和UTUC影像学证据( P＝0.29))比较差异均无统计学意义，UTUC组膀胱肿瘤直径大于非UTUC组( P＝0.02)。2例无UTUC影像学证据者发生UTUC，膀胱肿瘤直径均>3 cm。上尿路切除术后中位随访时间为42(17，65)个月，UTUC组5年生存率为55.6%，非UTUC组5年生存率为100.0%。随访期间2例死亡，均为UTUC组患者，非UTUC组7例均存活，两组的生存曲线比较差异无统计学意义( P＝0.29)。 结论:肾移植术后发生UTUC的NMIBC患者首发膀胱肿瘤直径显著大于未发生UTUC患者，其余临床特征无明显差异。对于首发膀胱肿瘤直径>3 cm的患者，可考虑行预防性上尿路切除手术。是否发生UTUC对患者的预后无明显影响。

abstractsObjective:We aim to investigate the clinical characteristics and prognosis of upper tract urothelial carcinoma (UTUC) in patients with non-muscle invasive bladder cancer (NMIBC) after renal transplantation.Methods:We retrospectively analyzed the clinical and follow-up information of 13 kidney recipients with NMIBC admitted to our hospital from January 2014 to June 2022 who subsequently underwent complete transperitoneal laparoscopic nephroureterectomy. There were 8 males and 5 females, aged (56.1±11.5), 3 cases with history of smoking and 10 cases without history of smoking, 4 cases with history of Aristolochic acids and 9 cases with no history of Aristolochic acids. Six and seven cases were treated with transurethral resection of bladder tumor for hematuria and bladder tumors detected by ultrasound or imaging respectively. Single and multiple bladder tumors were 9 and 4 cases; bladder tumor size ≤ 3 cm, >3 cm were 9 and 4 cases respectively; low-and high-grade bladder tumors were 3 and 10 cases separately, with; T a and T 1 of 3 and 10 cases respectively; recurrent bladder cancer and non-recurrent bladder cancer were 5 and 8 cases respectively. Follow-up after transurethral resection of bladder tumor showed that 6 cases with imaging evidence of UTUC for 6-52 months after transurethral resection of bladder tumor were treated with ipsilateral laparoscopic nephroureterectomy, including 2 cases of hydronephrosis, 1 case of renal pelvis mass, and 3 cases of ureteral mass, and 7 cases without imaging evidence of UTUC were performed with bilaterally prophylactic laparoscopic nephroureterectomy. The Kaplan-Meier curve and log-rank test were used for survival analysis to evaluate the prognostic effect of UTUC in kidney recipients with NMIBC. Results:Six of 13 patients named UTUC group were diagnosed with UTUC and 7 of 13 patients named no-UTUC group were not detected with UTUC. There was no statistical difference between these two groups in terms of clinical characteristics, including age( P=0.10), sex( P=0.10), smoking( P=0.19), history of Aristolochic acids( P=0.99), number( P=0.56), grade( P=0.19), stage ( P=0.19)and recurrence of bladder tumor number( P=0.10), and radiological findings of UTUC ( P=0.29). However, patients with larger-sized bladder tumors (larger than 3cm) had a higher rate of UTUC compared to patients with equal or smaller than 3 cm ( P=0.29). In addition, two patients with negative radiological findings developed UTUC following the detection of a large bladder tumor size (larger than 3 cm). The median survival of overall survival time and cancer specific survival time after laparoscopic nephroureterectomy were 42(17, 65) months. Two patients died from any cause during follow-up in patients with UTUC, whereas no significant difference between UTUC group and non-UTUC group in overall survival time and cancer specific survival time, as evaluated by the Kaplan-Meier curves and log-rank tests. ( P=0.29). Conclusions:After kidney transplantation, the diameter of the bladder tumor in NMIBC patients with UTUC was significantly larger than that in patients without UTUC, and no significant difference was observed in the remaining clinical features. Considering the non-functioning kidney after kidney transplantation, prophylactic laparoscopic nephroureterectomy can be considered for NMIBC patients with bladder tumor size >3 cm. Survival analysis showed no significant difference between UTUC group and non-UTUC group.