Meng S, Jiamei L
Shanghai Medical University, People's Republic of China.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Dec;90(6):689-93. doi: 10.1067/moe.2000.111411.
Renal transplantation is being improved, and life expectancy for patients with transplanted kidneys is being prolonged, but the incidence of malignant tumors in other body organs or tissues is increasing progressively. We investigated effective clinical plans for treating lingual cancer in persons who are long-term renal transplant recipients.
The group included 3 cases of lingual cancer after renal transplantation. All were men. The mean age was 47.5 years (range, 40 to 55). The lingual cancer occurred a mean of 9 years after renal transplantation. The lesions of two patients were in the left lingual margins; the other patient had multiple bilateral lesions. All diagnoses were confirmed microscopically to be squamous cell carcinomas stage I to II.
The doses of immunosuppressive agents were decreased, and two patients accepted surgery, chemotherapy, and radiotherapy. The third patient died 1 year after the cancer was diagnosed because of metastases. The other 2 patients had regular follow-up for 2 to 3 years and did not have either local recurrence or metastasis.
Patients who have lingual cancer develop after renal transplantation have received long-term immunosuppressive therapy. We suggest the following clinical protocol: (1) Besides regular evaluation after renal transplantation, physical examination and biopsy of suspicious oral lesions are necessary because of the possibility of postrenal malignancy. (2) Surgery, along with chemotherapy and radiotherapy, is the main treatment of lingual cancer after renal transplantation. (3) The lingual tumor should be comprehensively treated despite the poor immune state of the body, or tumor recurrence can accelerate and metastases can occur. (4) Treating cancer thoroughly and maintaining the function of the transplanted kidney can decrease the patient's immune status. We should continue to observe and to report the patients' protocol, even if the patients' clinical follow-up periods are limited.
肾移植技术不断改进，肾移植患者的预期寿命得以延长，但其他身体器官或组织的恶性肿瘤发病率却在逐渐上升。我们对长期肾移植受者舌癌的有效临床治疗方案进行了研究。
该组包括3例肾移植术后舌癌患者。均为男性。平均年龄47.5岁（范围40至55岁）。舌癌发生于肾移植术后平均9年。2例患者的病变位于左侧舌缘；另1例患者双侧有多处病变。所有诊断经显微镜检查确诊为Ⅰ至Ⅱ期鳞状细胞癌。
降低免疫抑制剂剂量，2例患者接受了手术、化疗和放疗。第3例患者在癌症确诊1年后因转移死亡。另外2例患者进行了2至3年的定期随访，未出现局部复发或转移。
肾移植后发生舌癌的患者接受了长期免疫抑制治疗。我们建议如下临床方案：（1）肾移植后除定期评估外，因存在肾后恶性肿瘤的可能性，对可疑口腔病变进行体格检查和活检是必要的。（2）手术联合化疗和放疗是肾移植术后舌癌的主要治疗方法。（3）尽管机体免疫状态较差，但舌部肿瘤仍应进行综合治疗，否则肿瘤复发会加速并发生转移。（4）彻底治疗癌症并维持移植肾的功能可降低患者的免疫状态。即使患者的临床随访期有限，我们仍应继续观察并报告患者的治疗方案。
