Urologic oncology
October 8, 2026 · via Europe PMC
Nonmuscle-invasive bladder cancer after solid organ transplantation: Clinical outcomes and recurrence patterns.
Guzman T, McSweeney S, Aydogdu C, +8 more, Bukavina L.
AI summary — for doctors, generated from the abstract only
In transplant recipients with nonmuscle-invasive bladder cancer, death from other causes was more common than recurrence, and tumor size over 3 cm predicted recurrence.
What was studied
Retrospective single-institution study of 59 solid organ transplant recipients diagnosed with NMIBC after transplant, using competing-risk methods to estimate recurrence and mortality.
Key findings
- 67.8% had high-risk disease; 11 of 59 (18.6%) recurred at a median of 15.1 months, all among those who received BCG induction.
- The 5-year cumulative incidence was 20.4% for recurrence versus 40.5% for competing mortality; all-cause mortality was 61.0% and bladder cancer-specific mortality was 8.5%.
- In univariable models, tumor size over 3 cm was associated with recurrence (HR 19.53, P = 0.005); progression to advanced disease occurred in 3 of 59.
Clinical relevance
Management in transplant recipients should weigh competing comorbidity and allograft preservation, favoring individualized multidisciplinary decisions and competing-risk-based prognosis.
Who should care
Limitations
Small single-center retrospective series, very wide uncertainty on the size hazard ratio, and limited detail on non-BCG intravesical regimens, so comparative efficacy could not be analyzed.
In this group, survival is shaped more by transplant-related comorbidity than by bladder cancer recurrence.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
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.
DOI
10.1016/j.urolonc.2026.08.020
PMID
42850079
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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