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论坛首页  >  医药生命科学动态跟踪   >  肿瘤
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【JAMA】美国实体器官移植受者的癌症风险谱

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这个帖子发布于9年零67天前，其中的信息可能已发生改变或有所发展。
美国实体器官移植受者的癌症风险谱

背景：由于免疫抑制和致癌病毒的感染，实体器官移植受者患癌症的风险有所增高。既往研究多涉及肾移植受者，故对不同器官移植受者的大规模研究可用以证实实体器官移植受者罹患癌症的病因。

目的：描述实体器官移植后器官受者罹患癌症的总体趋势

设计，环境与研究对象：该研究为队列研究，主要是对自美国器官移植受者登记系统（1987-2008）及13个州和地区的癌症登记中心的关联数据进行研究。

主要结果指标：用标准化发病率，（Standardized incidence ratios SIRs)和多余绝对风险（excess absolute risks EARs)来评估相对于普通人群器官移植受者的相对及绝对癌症风险。

结果：在美国器官移植登记系统及13个州和地区的癌症登记中心的关联数据中共关联到175732例实体器官移植患者（肾脏58.4%、肝脏21.6%、心脏10.0%、肺脏4.0%）的数据。其中10656例器官移植受者癌症的总体风险提高，发病率为1375/100000人年（SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] /100 000人年）。在32种患病风险增加的恶性肿瘤中，一些与已知感染有关（例如，直肠癌，卡波西肉瘤）一些与感染无关（例如，黑色素瘤，甲状腺和唇癌）。在风险升高的恶性肿瘤中最常见的是非霍奇金淋巴瘤(n = 1504; 发生率: 194.0 / 100 000 人年; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] /100 000人年)其次是肺癌 (n = 1344;发生率: 173.4 /100 000人年; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] / 100 000 人年),肝癌 (n = 930; 发生率: 120.0 /100 000 人年; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] /100 000 人年),以及肾癌 (n = 752; 发生率: 97.0 /100 000人年; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] / 100 000 人年)。肺癌的患病风险在肺移植受者中明显升高(SIR, 6.13 [95% CI, 5.18-7.21])，而在其他器官移植受者中也有升高。(肾移植受者：SIR, 1.46 [95% CI, 1.34-1.59];肝移植受者：SIR, 1.95 [95% CI, 1.74-2.19];心移植受者SIR, 2.67 [95% CI, 2.40-2.95])。肝癌的患病风险只在肝移植受者中升高(SIR, 43.83 [95% CI, 40.90-46.91])，主要表现在移植后6个月的一次异常风险(SIR, 508.97 [95% CI, 474.16-545.66])，以及 10到15年后的一次2倍超额风险(SIR, 2.22 [95% CI, 1.57-3.04])。在肾移植受者中，肾癌风险升高(SIR, 6.66 [95% CI, 6.12-7.23])并且呈双峰发作模式。肾癌患病风险在肝移植受者(SIR, 1.80 [95% CI, 1.40-2.29])和心脏移植受者中也同样会升高(SIR, 2.90 [95% CI, 2.32-3.59])。

结论：与普通人群相比，肾脏，肝脏，心脏或肺移植受者罹患各种与感染相关或无关的癌症风险会升高。

JAMA.2011;306(17):1891-1901.

Spectrum of Cancer Risk Among US Solid Organ Transplant Recipients

Abstract

Context Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology.

Objective To describe the overall pattern of cancer following solid organ transplantion.

Design, Setting, and Participants Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries.

Main Outcome Measures Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population.

Results The registry linkages yielded data on 175 732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10 656 cases and an incidence of 1375 per 100 000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100 000 person-years).Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma(n = 1504; incidence: 194.0 per 100 000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100 000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100 000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100 000 person-years),Liver (n = 930; incidence: 120.0 per 100 000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100 000 person-years),and kidney (n = 752; incidence: 97.0 per 100 000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100 000 person-years). lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months(SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]).Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]).

Conclusion Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.
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