Renal transplant recipients and patients with end stage renal disease present with more advanced bladder cancer

Abstract

Purpose: Renal transplant recipients have an increased incidence of bladder cancer. It is unknown whether these cancers are more aggressive than those in nontransplanted cases and whether this is also true for cases with end stage renal disease without renal transplantation.

Materials and methods: Surveillance, Epidemiology and End Results-Medicare data identified 97,942 patients with bladder cancer diagnosed between 1988 and 2002. We compared gender, race, tumor stage and histology at diagnosis among patients with a renal transplant, end stage renal disease or neither condition. The statistical significance of differences in the distribution of patient and tumor variables was assessed using the chi-square statistic (categorical variables) and single factor ANOVA tests of difference in means (continuous variables).

Results: Renal transplant recipients (58) were younger at diagnosis than those with end stage renal disease (400) or with neither diagnosis (97,484) (p <0.0001). Muscle invasive disease (stage T2 or greater) at presentation was more common in renal transplant recipients (37%, p = 0.04) and patients with end stage renal disease (33%, p = 0.0001) than in patients without these conditions (24%). Most renal transplant recipients were diagnosed with bladder cancer within 4 years of transplantation. Patients with a renal transplant (17%, p = 0.001) and end stage renal disease (12%, p <0.0001) also had a higher proportion of nonurothelial tumors than the remaining population (6.5%).

Conclusions: Renal transplant recipients and patients with end stage renal disease present with higher stage bladder cancer than those without these conditions despite closer medical supervision. Since most renal transplant recipients were diagnosed with bladder cancer within 4 years of undergoing renal transplantation, consideration should be given to bladder cancer screening of such patients in this period.