Risk of Rare Cancers Among Solid Organ Transplant Recipients.
Risk of Rare Cancers Among Solid Organ Transplant Recipients.
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DOI：
10.1093/jnci/djaa078
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发表时间：
2021-02-01
期刊：
影响因子：
--
通讯作者：
Engels EA
中科院分区：
文献类型：
--
作者：
D'Arcy ME;Castenson D;Lynch CF;Kahn AR;Morton LM;Shiels MS;Pfeiffer RM;Engels EA
免疫抑制的实体器官移植受者（SOTR）患某些由病毒引起的罕见癌症的几率较高。评估 SOTR 中罕见癌症的风险可能为与免疫力差和病毒感染相关的其他癌症提供病因学线索。 我们对来自美国 SOTR 登记处的 262~455 个 SOTR（1987-2014 年）进行了一项队列研究，这些 SOTR 与 17 个基于人群的癌症登记处相关。 SOTR 中的第一个癌症是使用基于部位和组织学的既定分类方案进行分类的。标准化发病率 (SIR) 将 SOTR 中的风险与一般人群进行了比较。我们根据免疫相关的 SOTR 特征，包括移植后的时间（即免疫抑制的持续时间），使用泊松回归来计算发病率比率。所有统计检验都是双面的。我们检查了 694 种不同的癌症亚型，其中 33 种表现出统计上显着升高的 SIR (Bonferroni P < 7.2 × 10–5)。所有 33 种癌症都很罕见（每 100000 人年发病率 <6 例），并且有几种已知病毒病因（例如默克尔细胞癌：SIR = 24.7，95% 置信区间 [CI] = 20.8 至 29.1）。其他增加的癌症包括唇部鳞状细胞癌（SIR范围 = 18.3-19.8）、眼睛和附件癌（SIR = 13.8，95% CI = 7.9至22.3）、唾液腺癌（SIR = 9.3，95% CI = 6.1至13.5）以及鼻腔和鼻窦癌（SIR = 4.5， 95% CI = 2.8 至 6.8)；皮脂腺癌（SIR = 34.3，95% CI = 26.3 至 44.0）；恶性纤维组织细胞瘤（15.4）；以及膀胱癌、肾癌、肺癌和结肠癌的亚型（SIR 范围 = 3.2-13.3）。自移植以来，多种癌症的发病率随着时间的推移而增加（Ptrend < .05），包括唇部、唾液腺和肛门生殖器部位的鳞状细胞癌。 SOTR 患多种罕见癌症的几率较高。由于其中一些癌症表现出侵袭性行为且预后不良，因此进一步表征免疫的作用以及致癌病毒的潜在参与对于改善预防和治疗非常重要。
Immunosuppressed solid organ transplant recipients (SOTRs) have elevated rates of certain rare cancers caused by viruses. Evaluating risk of rare cancers among SOTRs may provide etiological clues for additional cancers linked to poor immunity and viral infections. We performed a cohort study of 262 455 SOTRs (1987-2014) from the US SOTR registry linked to 17 population-based cancer registries. First cancers in SOTRs were categorized using an established classification scheme based on site and histology. Standardized incidence ratios (SIRs) compared risk in SOTRs with the general population. We used Poisson regression to calculate incidence rate ratios according to immune-related SOTR characteristics, including time since transplant (ie, duration of immunosuppression). All statistical tests were 2-sided. We examined 694 distinct cancer subtypes, with 33 manifesting statistically significantly elevated SIRs (Bonferroni P < 7.2 × 10–5). All 33 are rare (incidence <6 per 100 000 person-years) and several have known viral etiology (eg, Merkel cell carcinoma: SIR = 24.7, 95% confidence interval [CI] = 20.8 to 29.1). Additional cancers that were increased include squamous cell carcinomas of the lip (SIR range = 18.3-19.8), eye and adnexa (SIR = 13.8, 95% CI = 7.9 to 22.3), salivary gland (SIR = 9.3, 95% CI = 6.1 to 13.5), and nasal cavity and sinuses (SIR = 4.5, 95% CI = 2.8 to 6.8); sebaceous adenocarcinoma (SIR = 34.3, 95% CI = 26.3 to 44.0); malignant fibrous histiocytoma (15.4); and subtypes of bladder, kidney, lung, and colon cancer (SIR range = 3.2-13.3). Incidence of several cancers increased over time since transplant (Ptrend < .05), including squamous cell carcinomas of the lip, salivary gland, and anogenital sites. SOTRs experience elevated rates of several rare cancers. Because some of these cancers exhibit aggressive behavior with poor outcomes, it is important to further characterize the role of immunity and the potential involvement of oncogenic viruses to improve prevention and treatment.
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DOI：
10.1016/s2352-3018(17)30125-x
发表时间：
2017-11
期刊：
The lancet. HIV
影响因子：
--
作者：
Hernández-Ramírez RU;Shiels MS;Dubrow R;Engels EA
通讯作者：
Engels EA
影响因子：
4
作者：
Cao, Jian;Li, Dawei
通讯作者：
Li, Dawei
影响因子：
120.7
作者：
Engels, Eric A.;Pfeiffer, Ruth M.;Fraumeni, Joseph F., Jr.;Kasiske, Bertram L.;Israni, Ajay K.;Snyder, Jon J.;Wolfe, Robert A.;Goodrich, Nathan P.;Bayakly, A. Rana;Clarke, Christina A.;Copeland, Glenn;Finch, Jack L.;Fleissner, Mary Lou;Goodman, Marc T.;Kahn, Amy;Koch, Lori;Lynch, Charles F.;Madeleine, Margaret M.;Pawlish, Karen;Rao, Chandrika;Williams, Melanie A.;Castenson, David;Curry, Michael;Parsons, Ruth;Fant, Gregory;Lin, Monica
通讯作者：
Lin, Monica
影响因子：
168.9
作者：
Engels, EA;Frisch, M;Miller, RW
通讯作者：
Miller, RW
影响因子：
5.6
作者：
Afrogheh, Amir H.;Jakobiec, Frederick A.;Faquin, William C.
通讯作者：
Faquin, William C.