van Leeuwen Marina T, Grulich Andrew E, McDonald Stephen P, McCredie Margaret R E, Amin Janaki, Stewart John H, Webster Angela C, Chapman Jeremy R, Vajdic Claire M
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia.
Cancer Epidemiol Biomarkers Prev. 2009 Feb;18(2):561-9. doi: 10.1158/1055-9965.EPI-08-0919. Epub 2009 Feb 3.
Incidence of lip cancer is markedly increased after kidney transplantation. Immunosuppression and other risk factors for lip cancer were investigated in a population-based, nationwide cohort of 8,162 kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry (1982-2003). Lip cancer diagnoses were ascertained using probabilistic data linkage with the Australian National Cancer Statistics Clearing House. Standardized incidence ratios were used to compare lip cancer risk by subsite of lip and during periods of transplant function and failure. Risk factors during the first functioning transplant were examined using multivariate Poisson regression. Lip cancer was diagnosed in 203 patients. All cases were of squamous cell origin and mostly (77%) affected the lower vermillion. Cases occurred predominantly during periods of transplant function, with incidence decreasing to pretransplantation level on transplant failure and cessation of immunosuppression. During transplant function, cancer of the lower vermillion was associated with increasing year of age [incidence rate ratio (IRR), 1.03; 95% confidence interval (95% CI), 1.02-1.05], greater time since transplantation (P < 0.001), smoking (IRR, 2.13; 95% CI, 1.12-4.07), and current use of azathioprine (IRR, 2.67; 95% CI, 1.39-5.15) or cyclosporine (IRR, 1.63; 95% CI, 1.00-2.65). Female sex (IRR, 0.29; 95% CI, 0.18-0.46) and non-Australian/New Zealand country of birth (P = 0.006), surrogate indices of reduced exposure to solar UV radiation, were significantly protective. Lip cancer after transplantation is strongly related to the current receipt of immunosuppression. During transplant function, lip cancer risk is associated with the duration of immunosuppression, receipt of specific immunosuppressive agents, and UV exposure.
肾移植后唇癌的发病率显著增加。在澳大利亚和新西兰透析与移植登记处（1982 - 2003年）登记的8162名以人群为基础的全国性肾移植受者队列中，对唇癌的免疫抑制及其他风险因素进行了调查。唇癌诊断通过与澳大利亚国家癌症统计信息中心的概率数据关联来确定。标准化发病率比用于比较唇部不同亚部位以及移植功能期和移植失败期的唇癌风险。使用多变量泊松回归分析首次功能正常移植期间的风险因素。203例患者被诊断为唇癌。所有病例均为鳞状细胞起源，且大多数（77%）累及下唇红部。病例主要发生在移植功能期，移植失败及免疫抑制停止后发病率降至移植前水平。在移植功能期，下唇红部癌症与年龄增长相关[发病率比（IRR），1.03；95%置信区间（95%CI），1.02 - 1.05]、移植后时间更长（P < 0.001）、吸烟（IRR，2.13；95%CI，1.12 - 4.07）以及当前使用硫唑嘌呤（IRR，2.67；95%CI，1.39 - 5.15）或环孢素（IRR，1.63；95%CI，1.00 - 2.65）有关。女性（IRR，0.29；95%CI，0.18 - 0.46）以及出生于非澳大利亚/新西兰国家（P = 0.006），这两个太阳紫外线辐射暴露减少的替代指标具有显著的保护作用。移植后唇癌与当前接受免疫抑制密切相关。在移植功能期，唇癌风险与免疫抑制持续时间、特定免疫抑制剂的使用以及紫外线暴露有关。
