Ulrich Claas, Schmook Tobias, Sachse Michael M, Sterry Wolfram, Stockfleth Eggert
Department of Dermatology, Charité Hospital, Berlin, Germany.
Dermatol Surg. 2004 Apr;30(4 Pt 2):622-7. doi: 10.1111/j.1524-4725.2004.30147.x.
Organ transplantation has been performed for almost 40 years with steadily increasing success regarding long-time survival of the graft as well as quality of life for the patient. An increase of skin cancers as a consequence of the lowered cellular immune response seems to parallel the overall increased survival rate of organ transplant recipients. Against the background of chronic immunosuppression, known risk factors like the amount of sun exposure before and after transplantation and oncogenic viruses as well as the genetic background and place of residence (latitude) are strongly related with the increased skin cancer incidence. The goal of this review is to compare the epidemiologic prevalence of nonmelanoma skin cancer between various geographic locations and to highlight pathogenesis factors.
This study was based on a review of the current literature.
The increasing incidence of nonmelanoma skin cancer paralleling a prolonged survival of patients after organ transplantation represents a significant reason for morbidity and long-term mortality in organ transplant recipients worldwide. The incidence of nonmelanoma skin cancer in liver, kidney, and heart transplant recipients varies from 1.5% to 22%, 2% to 24%, and 6% to 34%, respectively, within 5 years of transplantation depending on geographic location and other pathogenesis factors. Ultraviolet radiation (UVR) as well as immunosuppressant therapy are crucial risk factors regarding the induction and progression of skin cancer. UVR is related to the induction of DNA damage as well as interference with Langerhans cell antigen presentation and a TH1-TH2 shift induced via release of IL-10. Whereas the overall duration of immunosuppression and the accumulative dosage applied are relevant measures in the pathogenesis of an increased tumor risk, individual differences between specific immunosuppressive agents are more difficult to assess.
Multiple international studies assess risk factors and pathophysiology of skin cancer in organ transplant patients, with variable results in the literature. Large multicenter studies with thorough multivariant analysis may provide useful information for center-independent analysis of pathogenesis factors for transplant-related skin cancer.
器官移植已开展近40年，在移植物长期存活以及患者生活质量方面取得了稳步提高。由于细胞免疫反应降低导致皮肤癌发病率上升，这似乎与器官移植受者总体存活率的提高相平行。在慢性免疫抑制的背景下，已知的危险因素，如移植前后的日晒量、致癌病毒以及遗传背景和居住地（纬度），与皮肤癌发病率的增加密切相关。本综述的目的是比较不同地理位置非黑色素瘤皮肤癌的流行病学患病率，并突出发病机制因素。
本研究基于对当前文献的综述。
非黑色素瘤皮肤癌发病率的上升与器官移植后患者生存期的延长相平行，这是全球器官移植受者发病和长期死亡的一个重要原因。根据地理位置和其他发病机制因素，肝、肾和心脏移植受者在移植后5年内非黑色素瘤皮肤癌的发病率分别为1.5%至22%、2%至24%和6%至34%。紫外线辐射（UVR）以及免疫抑制治疗是皮肤癌发生和进展的关键危险因素。UVR与DNA损伤的诱导、朗格汉斯细胞抗原呈递的干扰以及通过白细胞介素-10释放诱导的TH1-TH2转变有关。虽然免疫抑制的总持续时间和应用的累积剂量是肿瘤风险增加发病机制中的相关指标，但特定免疫抑制剂之间的个体差异更难评估。
多项国际研究评估了器官移植患者皮肤癌的危险因素和病理生理学，文献中的结果各不相同。进行全面多变量分析的大型多中心研究可能为独立于中心的移植相关皮肤癌发病机制因素分析提供有用信息。
