Cancer incidence in blood transfusion recipients
Cancer incidence in blood transfusion recipients
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DOI：
10.1093/jnci/djm248
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发表时间：
2007-12-19
影响因子：
10.3
通讯作者：
Melbye, Mads
中科院分区：
文献类型：
--
作者：
Hjalgrim, Henrik;Edgren, Gustaf;Melbye, Mads
背景输血可能通过生物制剂的传递和免疫系统的调节来影响受者的癌症风险。方法我们利用斯堪的纳维亚血库的计算机档案，确定了888843名1968年以后接受输血的无癌受者的队列。受试者从第一次登记输血开始跟踪，直到死亡、移民、癌症诊断或2002年12月31日，以先到者为准。相对风险以观察到的癌症数量与预期癌症数量的比率表示，即标准化发病率比率(SIRS)，以丹麦和瑞典普通人口的发病率为参考。结果在5652918人年的随访中，受血者发生癌症80990例，SIR为1.45(95%可信区间[CI]=1.44~1.46)。总的癌症SIR从输血后前6个月的5.36(95%CI=5.29)降至输血后2年以上随访期的1.10或以下。但在输血后10年以上，舌癌、口腔癌、咽癌、食道癌、肝癌、呼吸道和尿道癌以及鳞状细胞皮肤癌的标化发病率仍然较高。结论输血后不久癌症风险显著增加，这可能反映了未确诊的隐匿性癌症的存在，其症状需要输血。与烟草和酒精相关的癌症风险的持续增加表明，与促使输血的条件有关的生活方式和其他风险因素本身，而不是与输血相关的暴露本身，对观察到的接受者的癌症发生很重要。
Background Blood transfusions may influence the recipients' cancer risks both through transmission of biologic agents and by modulation of the immune system. However, cancer occurrence in transfusion recipients remains poorly characterized.Methods We used computerized files from Scandinavian blood banks to identify a cohort of 888843 cancer-free recipients transfused after 1968. The recipients were followed from first registered transfusion until the date of death, emigration, cancer diagnosis, or December 31, 2002, whichever came first. Relative risks were expressed as ratios of the observed to the expected numbers of cancers, that is, standardized incidence ratios (SIRs), using incidence rates for the general Danish and Swedish populations as a reference. All statistical tests were two-sided.Results During 5652918 person-years of follow-up, 80990 cancers occurred in the transfusion recipients, corresponding to a SIR of 1.45 (95% confidence interval [CI] = 1.44 to 1.46). The SIR for cancer overall decreased from 5.36 (95% CI = 5.29 to 5.43) during the first 6 months after transfusion to 1.10 or less for follow-up periods more than 2 years after the transfusion. However, the standardized incidence ratios for cancers of the tongue, mouth, pharynx, esophagus, liver, and respiratory and urinary tracts and for squamous cell skin carcinoma remained elevated beyond 10 years after the transfusion.Conclusions The marked increase in cancer risk shortly after a blood transfusion may reflect the presence of undiagnosed occult cancers with symptoms that necessitated the blood transfusion. The continued increased risk of tobacco- and alohol-related cancers suggests that lifestyle and other risk factors related to conditions prompting transfusion rather than transfusion-related exposures per se are important to the observed cancer occurrence in the recipients.