Cancer risks after solid organ transplantation and after long-term dialysis
Cancer risks after solid organ transplantation and after long-term dialysis
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DOI：
10.1002/ijc.30531
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发表时间：
2017-03-01
影响因子：
6.4
通讯作者：
Bzhalava, Davit
中科院分区：
文献类型：
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作者：
Hortlund, Maria;Muhr, Laila Sara Arroyo;Bzhalava, Davit
免疫抑制涉及无法控制病毒感染和病毒相关癌症的发病率增加。一些没有已知病毒病因的癌症也增加了，但关于确切的癌症形式增加的数据一直不一致。为了提供一个可靠的和可推广的估计，具有较高的统计功效和较长的随访时间，我们在两个不同的国家和两个不同的免疫抑制患者组（实体器官移植受者（OTR）和长期透析患者（LDPs））中使用全面的、基于人群的登记研究评估了癌症风险。丹麦和瑞典的国家登记处确定了20，804例OTR和31，140例LDP，并使用国家癌症登记处进行了随访。估计了与一般人群相比的标准化发病率比（SIR）。我们发现两个不同国家和两个不同免疫抑制队列的结果高度相似，即以下特定癌症形式的发病率增加：非黑色素瘤皮肤癌（NMSC），非霍奇金淋巴瘤以及唇癌，肾癌，喉癌和甲状腺癌。OTR中总体癌症的SIR在瑞典为3.5 [n = 2，142，95% CI，3.4-3.7]，在丹麦为2.9 [n = 1，110，95% CI，2.8-3.1]，在LDP中为1.6 [n = 1，713，95% CI，1.5-1.6]。瑞典OTR中NMSC的SIR为44.7 [n = 994，95% CI，42-47.5]，丹麦为41.5 [n = 445，95% CI，37.8-45.5]。LDP中NMSC的SIR增加为5.3 [n = 304，95% CI，4.7-5.9]）。总之，在免疫抑制者中，一致地发现特定的、相似的癌症形式的SIR增加。可能的解释包括监测偏倚和免疫抑制相关的病毒感染易感性。
Immunosuppression involves an inability to control virus infections and increased incidence of virus-associated cancers. Some cancers without known viral etiology are also increased, but data on exactly which cancer forms are increased has been inconsistent. To provide a reliable and generalizable estimate, with high statistical power and long follow-up time, we assessed cancer risks using comprehensive, population-based registries in two different countries and from two different immunosuppressed patient groups (solid organ transplant recipients (OTRs) and long-term dialysis patients (LDPs)). National registries in Denmark and Sweden identified 20,804 OTRs and 31,140 LDPs that were followed up using national cancer registries. Standardized incidence ratios (SIR) compared to the general population were estimated. We found highly similar results, both for the two different countries and for the two different immunosuppressed cohorts, namely an increased incidence for the following specific cancer forms: Non-melanoma skin cancer (NMSC), non-Hodgkin's lymphoma and cancers of the lip, kidney, larynx and thyroid. The SIR for overall cancer among OTRs was 3.5 [n = 2,142, 95% CI, 3.4-3.7] in Sweden, 2.9 [n = 1,110, 95% CI, 2.8-3.1] in Denmark and 1.6 [n = 1,713, 95% CI, 1.5-1.6] among LDP. The SIR for NMSC among OTRs was 44.7 [n = 994, 95% CI, 42-47.5] in Sweden and 41.5 [n = 445, 95% CI, 37.8-45.5] in Denmark. The increased SIR for NMSC among LDPs was 5.3 [n = 304, 95% CI, 4.7-5.9]). In summary, an increased SIR for a specific, similar set of cancer forms is consistently found among the immunosuppressed. Conceivable explanations include surveillance bias and immunosuppression-related susceptibility to viral infections.