Spectrum of cancer risk among US solid organ transplant recipients.
Spectrum of cancer risk among US solid organ transplant recipients.
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DOI：
10.1001/jama.2011.1592
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发表时间：
2011-11-02
影响因子：
120.7
通讯作者：
Lin, Monica
中科院分区：
文献类型：
--
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
由于免疫抑制和致癌病毒感染，实体器官移植受者的癌症风险增加。由于大多数先前的研究都涉及肾脏接受者，因此包括不同器官接受者的大型研究可以告知癌症病因。描述实体器官移植受者中癌症的总体模式。队列研究使用来自美国移植受者科学登记处（1987-2008）和13个州/地区癌症登记处的相关数据。美国实体器官移植受者标准化发病率比（SIR）和超额绝对风险（EAR）评估移植受者与普通人群相比的相对和绝对癌症风险。登记关联产生了175，732例实体器官移植的数据（58.4%肾脏，21.6%肝脏，10.0%心脏，4.0%肺）。总体癌症风险升高（N= 10，656例病例，发病率为每100，000人年1374.7例; SIR 2.10，95%CI 2.06-2.14; EAR 719.3，95%CI 693.3-745.6，每100，000人年）。32种不同的恶性肿瘤的风险增加（p<0.001），一些与已知的感染有关（例如，肛门癌，卡波西肉瘤）和其它不相关的（例如，黑色素瘤、甲状腺癌和唇癌）。最常见的恶性肿瘤的风险增加是非霍奇金淋巴瘤（N=1504，发病率194.0; SIR 7.54，95%CI 7.17-7.93; SIR 168.3，95%CI 158.6-178.4）和肺癌（N=1344，发生率173.4; SIR 1.97，95%CI 1.86-2.08; SIR 85.3，95%CI 76.2-94.8），肝脏（N=930，发生率120.0; SIR 11.56，95%CI 10.83-12.33; SIR 109.6，95%CI 102.0-117.6）和肾脏（N=752，发生率97.0; SIR 4.65，95%CI 4.32-4.99; SIR 76.1，95%CI 69.3-83.3）。肺癌风险在肺受体中最高（SIR 6.13，95%CI 5.18-7.21），但在其他受体中也增加（SIR 1.46，95%CI 1.34-1.59，肾脏; 1.95，1.74-2.19，肝脏; 2.67，2.40-2.95，心脏）。肝癌仅在肝移植受者中升高（SIR 43.83，95%CI 40.90-46.91），在前6个月表现出异常的风险（SIR 508.97，95%CI 474.16-545.66），并在10-15年内持续2倍的风险（SIR 2.22，95%CI 1.57-3.04）。在肾移植受者中，肾癌发病率升高（SIR 6.66，95%CI 6.12-7.23），发病呈双峰型。肾癌在肝脏和心脏受者中也增加（SIR分别为1.80，95%CI 1.40-2.29和2.90，2.32-3.59）。与一般人群相比，肾、肝、心脏或肺移植的接受者患各种感染相关和不相关癌症的风险增加。
Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Since most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology. Describe the overall pattern of cancer among solid organ transplant recipients. Cohort study using linked data from the U.S. Scientific Registry of Transplant Recipients (1987–2008) and 13 state/regional cancer registries. Solid organ transplant recipients in the U.S. Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared to the general population. Registry linkages yielded data on 175,732 solid organ transplants (58.4% kidney, 21.6% liver, 10.0% heart, 4.0% lung). Overall cancer risk was elevated (N=10,656 cases, incidence 1374.7 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 (p<0.001) for 32 different malignancies, some related to known infections (e.g., anal cancer, Kaposi sarcoma) and others unrelated (e.g., melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (N=1504, incidence 194.0; SIR 7.54, 95%CI 7.17–7.93; EAR 168.3, 95%CI 158.6–178.4) and cancers of the lung (N=1344, incidence 173.4; SIR 1.97, 95%CI 1.86–2.08; EAR 85.3, 95%CI 76.2–94.8), liver (N=930, incidence 120.0; SIR 11.56, 95%CI 10.83–12.33; EAR 109.6, 95%CI 102.0–117.6), and kidney (N=752, incidence 97.0; SIR 4.65, 95%CI 4.32–4.99; EAR 76.1, 95%CI 69.3–83.3). Lung cancer risk was most elevated in lung recipients (SIR 6.13, 95%CI 5.18–7.21) but also increased among other recipients (SIR 1.46, 95%CI 1.34–1.59 for kidney; 1.95, 1.74–2.19 for liver; 2.67, 2.40–2.95 for heart). Liver cancer 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 continuing two-fold excess for 10–15 years (SIR 2.22, 95%CI 1.57–3.04). Among kidney recipients, kidney cancer was elevated (SIR 6.66, 95%CI 6.12–7.23) and bimodal in onset. Kidney cancer was also increased in liver and heart recipients (SIR 1.80, 95%CI 1.40–2.29, and 2.90, 2.32–3.59, respectively). Recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers, compared with the general population.
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