Hjalgrim Henrik, Edgren Gustaf, Rostgaard Klaus, Reilly Marie, Tran Trung Nam, Titlestad Kjell Einar, Shanwell Agneta, Jersild Casper, Adami Johanna, Wikman Agneta, Gridley Gloria, Wideroff Louise, Nyrén Olof, Melbye Mads
Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen South, Denmark.
J Natl Cancer Inst. 2007 Dec 19;99(24):1864-74. doi: 10.1093/jnci/djm248. Epub 2007 Dec 11.
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.
We used computerized files from Scandinavian blood banks to identify a cohort of 888,843 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.
During 5,652,918 person-years of follow-up, 80,990 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.
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 alcohol-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.
输血可能通过生物制剂的传播以及免疫系统的调节来影响受血者患癌风险。然而，输血受血者中癌症的发生情况仍未得到充分描述。
我们利用斯堪的纳维亚血库的计算机化文件，确定了一组1968年后接受输血的888,843名无癌受血者。对受血者从首次登记输血开始进行随访，直至死亡、移民、癌症诊断或2002年12月31日（以先发生者为准）。相对风险以观察到的癌症病例数与预期癌症病例数的比值表示，即标准化发病比（SIR），以丹麦和瑞典普通人群的发病率作为参考。所有统计检验均为双侧检验。
在5,652,918人年的随访期间，输血受血者中发生了80,990例癌症，标准化发病比为1.45（95%置信区间[CI]=1.44至1.46）。总体癌症的标准化发病比从输血后前6个月的5.36（95%CI=5.29至5.43）降至输血后2年以上随访期的1.10或更低。然而，舌、口、咽、食管、肝、呼吸道和泌尿道癌症以及鳞状细胞皮肤癌的标准化发病比在输血后10年以上仍保持升高。
输血后不久癌症风险的显著增加可能反映了存在因症状而需要输血的未被诊断的隐匿性癌症。与烟草和酒精相关癌症的持续风险增加表明，生活方式和与促使输血的疾病相关的其他风险因素，而非输血相关暴露本身，对受血者中观察到的癌症发生具有重要影响。
