Piselli Pierluca, Busnach Ghil, Citterio France, Richiardi Lorenzo, Cimaglia Claudia, Angeletti Claudio, Doringhet Patrizia V, Pozzetto Ubaldo, Perrino Maria L, Serraino Diego
Dipartimento di epidemiologia e ricerca pre-clinica, Istituto nazionale per la malattie Infettive (INMI) "L. Spallanzani", Roma.
Epidemiol Prev. 2008 Jul-Oct;32(4-5):205-11.
This investigation aimed at highlighting the cancer risk of recipients of kidney transplant in northern and central Italy.
Data on 2,120 kidney transplant recipients from Niguarda Ca' Granda Hospital Milan, or from Policlinico "A. Gemelli", Rome, were analyzed The period at risk of developing cancer (person-years, PY) was computed from 30 days after transplant to date of cancer diagnosis, or date of death, or date of re-entering dialysis, or date of last follow-up. Observed and expected numbers of cancer were compared through sex- and age-standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). The transplant attributable fraction (AF) of cancer cases and incidence rate ratios (IRR) were also computed.
After 16.594 PY of follow-up (median flow-up: 6.8 years), 121 cancer cases were diagnosed (729.2 cases/10(5) PY). The SIR for all cancers was 1.9. Kaposi's sarcoma (KS) (27 cases observed, SIR = 82) and non-Hodgkins lymphoma (NHL) (18 cases observed a SIR = 6.4 were the most common cancers. Significantly increased SIRs were also noted for native kidney (11 cases observed SIR = 4.9), corpus uteri (6 cases observed SIR = 4.6), and liver (6 cases observed, SIR = 3.1). The transplant AF was 46.9%, largely due to KS (98.8%) and NHL (84.3%). Since SIRs decreased with increasing age, the transplant AF ranged from 73.2% below 45 years of age to 30.4% after 54. Among risk factors, area of birth strongly influenced the risk of KS, with a 3-fold higher risk in those born in the South of Italy as compared to those born in the northern part.
Immune depression after kidney transplantation entails a two-fold increased overall risk of cancer, mainly related to cancers associated to a viral aetiology. Furthermore, our findings suggest the need to adopt a specific serological screening for the prevention of post-transplant KS in individuals born in southern Italy.
本研究旨在突出意大利北部和中部肾移植受者的癌症风险。
分析了来自米兰尼瓜尔达·卡格兰达医院或罗马“阿·杰梅利”综合医院的2120例肾移植受者的数据。从移植后30天至癌症诊断日期、死亡日期、重新开始透析日期或最后随访日期计算发生癌症的风险期（人年，PY）。通过性别和年龄标准化发病率比（SIR）和95%置信区间（CI）比较观察到的和预期的癌症病例数。还计算了癌症病例的移植归因分数（AF）和发病率比（IRR）。
经过16594人年的随访（中位随访时间：6.8年），诊断出121例癌症病例（729.2例/10⁵人年）。所有癌症的SIR为1.9。卡波西肉瘤（KS）（观察到27例，SIR = 82）和非霍奇金淋巴瘤（NHL）（观察到18例，SIR = 6.4）是最常见的癌症。在原发性肾（观察到11例，SIR = 4.9）、子宫体（观察到6例，SIR = 4.6）和肝脏（观察到6例，SIR = 3.1）中也观察到SIR显著升高。移植AF为46.9%，主要归因于KS（98.8%）和NHL（84.3%）。由于SIR随年龄增加而降低，移植AF范围从45岁以下的73.2%到54岁以后的30.4%。在危险因素中，出生地对KS风险有强烈影响，出生在意大利南部的人患KS的风险比出生在北部的人高3倍。
肾移植后的免疫抑制使总体癌症风险增加两倍，主要与病毒病因相关的癌症有关。此外，我们的研究结果表明，有必要对出生在意大利南部的个体采取特定的血清学筛查以预防移植后KS。
