CANCER RISK AFTER RENAL-TRANSPLANTATION IN THE NORDIC COUNTRIES, 1964-1986
CANCER RISK AFTER RENAL-TRANSPLANTATION IN THE NORDIC COUNTRIES, 1964-1986
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DOI：
10.1002/ijc.2910600209
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发表时间：
1995-01-17
影响因子：
6.4
通讯作者：
PUKKALA, E
中科院分区：
文献类型：
--
作者：
BIRKELAND, SA;STORM, HH;PUKKALA, E
免疫能力降低的情况下可能会发生癌症的理论得到了对免疫缺陷的人类观察的支持，例如器官移植后发生的免疫缺陷。然而，还没有对人类进行的研究，在这些研究中，参考人群与癌症病例发生时的人群相同，并且有足够长的随访期。1964-1982年期间5692名北欧肾移植受者的资料与国家癌症登记处(1964-1986年)和人口登记处有联系。从第一次移植之日到死亡或研究期结束，计算风险年，并乘以适当的年龄和日历特定发病率，得出预期的癌症数量。标准化发病率比(SIR)在分层后通过一些记录变量计算。总共累积了32,392人年，发生了471例癌症，男性的总体SIR为4.6(95%CI，4.0~5.2)，女性的SIR为4.5(95%CI，4.0~5.2)。在结肠癌、喉癌、肺癌和膀胱癌以及男性前列腺癌和睾丸癌中，男性的总体风险都是男性的2-5倍。与唇癌、皮肤癌(非黑色素瘤)、肾癌和内分泌腺癌、非霍奇金淋巴瘤以及宫颈癌和外阴阴道癌有关的风险比预期高出10倍至30倍。在所研究的供受者变量中，包括组织类型和相容(ABO、HLA、DR)，移植时年龄在45岁以下是大多数部位风险增加的最重要的决定因素。肾移植在短期和长期都会增加患癌症的风险，这与免疫系统受损允许致癌因素发挥作用的理论是一致的。与移植的益处相比，肿瘤风险很小，但应该对患者进行随访，看是否有癌症的迹象。(C)1995年Wiley-Liss公司
The theory that cancer may arise under conditions of reduced immune capacity is supported by observations of humans with immune deficiencies such as occur following organ transplants. However, no study on humans has been done in which the reference population was the same as that in which the cancer cases arose and in which there was a sufficiently long period of follow-up. Information on 5,692 Nordic recipients of renal transplants in 1964-1982 was linked with the national cancer registries (1964-1986) and population registries. Person-years at risk were calculated from the date of first transplantation until death or the end of the study period and were multiplied by the appropriate age- and calender-specific incidence rates to obtain the expected numbers of cancers. Standardized incidence ratios (SIR) were calculated after stratification by a number of recorded variables. Altogether, 32,392 person-years were accrued, and 471 cancers occurred, yielding overall SIR of 4.6 (95% CI, 4.0 to 5.2) for males and 4.5 (95% CI, 4.0 to 5.2) for females. Significant overall 2- to 5-fold excess risks in both sexes were seen for cancers of the colon, larynx, lung and bladder, and in men also far cancers of the prostate and testis. Notably high risks, 10-fold to 30-fold above expectation, were associated with cancers of the lip, skin (non-melanoma), kidney and endocrine glands, also with non-Hodgkin's lymphoma, and in women also with cancers of the cervix and vulva-vagina. Among a number of donor and recipient variables studied, including tissue types and compatibility (ABO, HLA, DR), age below 45 years at the time of transplantation was the most important determinant for increased risk at most sites. Kidney transplantation increases the risk of cancer in the short and in the long term, consistent with the theory that an impaired immune system allows carcinogenic factors to act. The tumor risk is small in comparison with the benefits of transplants, but patients should be followed up for signs of cancer. (C) 1995 Wiley-Liss, Inc.