Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Can Respir J. 2010 Jan-Feb;17(1):e7-13. doi: 10.1155/2010/183936.
Many factors may limit survival from lung and heartlung transplantation, including malignancy.
To investigate factors associated with the development of malignancy following transplantation and its effect on survival by retrospectively reviewing a population of lung transplant recipients.
Data from 342 consecutive lung transplant patients were collected. Results were analyzed by fitting variables into a multivariate logistic regression model predicting the development of post-transplant malignancies. Covariates were selected based on crude associations that reached a level of significance at P ≤ 0.10. Length of survival was analyzed using the Kaplan-Meier method.
Fifty-eight subjects developed post-transplant malignancies, which were the cause of death of 14 patients. Twenty-one patients had a pretransplant malignancy, of whom six developed a malignancy posttransplant--of these, two were fatal recurrences. No risk factors were significantly associated with all forms of post-transplant malignancy. When adjusted for age at transplantation and donor smoking history, Epstein-Barr virus seropositivity at the time of transplant was significantly associated with a reduced risk of a post-transplant lymphoproliferative disorder (OR 0.17; 95% CI 0.05 to 0.59). The median survival time in individuals without a post-transplant malignancy was significantly shorter than in those with a post-transplant malignancy (P = 0.018 Wilcoxon [Breslow]). This may be secondary to the length of time required to develop malignancy and the fact that not all malignancies that developed were fatal. The median time to develop malignancy was greater than two years. In addition, the 14 patients who died as a result of their malignancy had a significantly shorter survival time than the 44 who died because of nonmalignant causes (P < 0.001).
Malignancy was not associated with an overall decrease in survival time when compared with those who did not develop a malignancy. Risk factors specific for the development of malignancies remain difficult to specify.
许多因素可能会限制肺和心肺移植的存活率，包括恶性肿瘤。
通过回顾性分析一组肺移植受者的资料，研究移植后发生恶性肿瘤的相关因素及其对存活率的影响。
收集了 342 例连续肺移植患者的数据。通过将变量拟合到预测移植后恶性肿瘤发生的多变量逻辑回归模型中，对结果进行分析。根据在 P≤0.10 时达到显著水平的粗关联，选择协变量。
58 例患者发生移植后恶性肿瘤，其中 14 例患者因恶性肿瘤死亡。21 例患者在移植前患有恶性肿瘤，其中 6 例在移植后发生恶性肿瘤，其中 2 例为致命复发。没有明显的危险因素与所有形式的移植后恶性肿瘤相关。当调整移植时的年龄和供体吸烟史后，移植时 EBV 血清阳性与移植后淋巴增殖性疾病的风险降低显著相关（OR 0.17；95%CI 0.05 至 0.59）。无移植后恶性肿瘤患者的中位生存时间明显短于有移植后恶性肿瘤患者（P=0.018 Wilcoxon [Breslow]）。这可能是由于发生恶性肿瘤所需的时间以及并非所有发生的恶性肿瘤都是致命的。发生恶性肿瘤的中位时间大于两年。此外，由于恶性肿瘤而死亡的 14 例患者的生存时间明显短于因非恶性原因而死亡的 44 例患者（P<0.001）。
与未发生恶性肿瘤的患者相比，恶性肿瘤的发生并不与总生存时间的缩短相关。发生恶性肿瘤的特定危险因素仍难以确定。
