Lindelöf B, Sigurgeirsson B, Gäbel H, Stern R S
Department of Dermatology, Karolinska Hospital and Institute, Box 120, S-171 76 Stockholm, Sweden.
Br J Dermatol. 2000 Sep;143(3):513-9.
Skin cancer following solid organ transplantation is an important cause of morbidity in long-term survivors. This risk is well known but imprecisely quantified.
We aimed to determine: (i) the skin cancer risks in transplant patients more precisely; (ii) whether the risk of malignant melanoma is altered; and (iii) whether the risk of epithelial cancers occurring at non-exposed sites is comparable with that seen in sun-exposed sites.
We linked a population-based cohort of 5356 patients who had received organ transplants in Sweden between 1970 and 1994 with the compulsory Swedish Cancer Registry, to identify all cancer cases except basal cell carcinomas, which are not registered.
After a mean follow-up of 5.6 years post-transplantation, 172 of 5356 patients developed 325 non-melanoma skin cancers (excluding basal cell carcinomas) and six malignant melanomas. The relative risk of non-melanoma skin cancer was 108.6 [95% confidence interval (CI) 94.6-123.1] for men and 92.8 (95% CI 73.2-116.0) for women. The highest risks were noted for upper limbs, and the risk increased with time. No significant increase in malignant melanomas was noted: the relative risk was 1.6 (95% CI 0.5-3.7) for men and 0.5 (95% CI 0. 0-2.6) for women. Except for the lip, which is also sun-exposed, other epithelial sites did not show comparable increases in cancer risk.
We conclude that organ transplant recipients are at a highly increased risk for non-melanoma skin cancer and must be closely followed throughout their lives. Cancer risk associated with transplantation is higher for sun-exposed than for non-sun-exposed epithelial tissues, even among populations living in regions with low solar insolation.
实体器官移植后发生皮肤癌是长期存活者发病的重要原因。这种风险众所周知，但量化并不精确。
我们旨在确定：（i）更精确地确定移植患者患皮肤癌的风险；（ii）恶性黑色素瘤的风险是否改变；（iii）非暴露部位发生上皮癌的风险与暴露部位相比是否相当。
我们将1970年至1994年期间在瑞典接受器官移植的5356名患者的基于人群的队列与瑞典强制性癌症登记处相联系，以识别除未登记的基底细胞癌之外的所有癌症病例。
移植后平均随访5.6年，5356名患者中有172人发生了325例非黑色素瘤皮肤癌（不包括基底细胞癌）和6例恶性黑色素瘤。男性非黑色素瘤皮肤癌的相对风险为108.6 [95%置信区间（CI）94.6 - 123.1]，女性为92.8（95%CI 73.2 - 116.0）。上肢的风险最高，且风险随时间增加。未观察到恶性黑色素瘤有显著增加：男性的相对风险为1.6（95%CI 0.5 - 3.7），女性为0.5（95%CI 0.0 - 2.6）。除同样暴露于阳光的唇部外，其他上皮部位的癌症风险未显示出相当程度的增加。
我们得出结论，器官移植受者患非黑色素瘤皮肤癌的风险大幅增加，必须终生密切随访。即使在日照量低的地区人群中，与移植相关的癌症风险在暴露于阳光的上皮组织中也高于未暴露于阳光的上皮组织。
