Jiang Ying, Villeneuve Paul J, Fenton Stanley S A, Schaubel Douglas E, Lilly Les, Mao Yang
Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Liver Transpl. 2008 Nov;14(11):1588-97. doi: 10.1002/lt.21554.
Characterization of the long-term cancer risks among liver transplant patients has been hampered by the paucity of sufficiently large cohorts. The increase over time in the number of liver transplants coupled with improved survival underscores the need to better understand associated long-term health effects. This is a cohort study whose subjects were assembled with data from the population-based Canadian Organ Replacement Registry. Analyses are based on 2034 patients who received a liver transplant between June 1983 and October 1998. Incident cases of cancer were identified through record linkage to the Canadian Cancer Registry. We compared site-specific cancer incidence rates in the cohort and the general Canadian population by using the standardized incidence ratio (SIR). Stratified analyses were performed to examine variations in risk according to age at transplantation, sex, time since transplantation, and year of transplantation. Liver transplant recipients had cancer incidence rates that were 2.5 times higher than those of the general population [95% confidence interval (CI) = 2.1, 3.0]. The highest SIR was observed for non-Hodgkin's lymphoma (SIR = 20.8, 95% CI = 14.9, 28.3), whereas a statistically significant excess was observed for colorectal cancer (SIR = 2.6, 95% CI = 1.4, 4.4). Risks were more pronounced during the first year of follow-up and among younger transplant patients. In conclusion, our findings indicate that liver transplant patients face increased risks of developing cancer with respect to the general population. Increased surveillance in this patient population, particularly in the first year following transplantation, and screening for colorectal cancer with modalities for which benefits are already well recognized should be pursued.
由于缺乏足够大的队列研究，肝移植患者长期癌症风险的特征一直难以明确。随着时间的推移，肝移植数量的增加以及生存率的提高，凸显了更好地了解相关长期健康影响的必要性。这是一项队列研究，其研究对象是根据基于人群的加拿大器官移植登记处的数据收集而来的。分析基于1983年6月至1998年10月期间接受肝移植的2034名患者。通过与加拿大癌症登记处的记录链接来确定癌症的发病病例。我们使用标准化发病比（SIR）比较了该队列和加拿大普通人群中特定部位的癌症发病率。进行分层分析以检查根据移植时的年龄、性别、移植后的时间以及移植年份的风险差异。肝移植受者的癌症发病率比普通人群高2.5倍[95%置信区间（CI）=2.1，3.0]。非霍奇金淋巴瘤的SIR最高（SIR=20.8，95%CI=14.9，28.3），而结直肠癌的发病率有统计学意义的显著增加（SIR=2.6，95%CI=1.4，4.4）。风险在随访的第一年以及年轻的移植患者中更为明显。总之，我们的研究结果表明，与普通人群相比，肝移植患者面临更高的患癌风险。应加强对该患者群体的监测，特别是在移植后的第一年，并采用已被充分认可其益处的方法对结直肠癌进行筛查。
