Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya.
Ann Oncol. 2014 Feb;25(2):435-41. doi: 10.1093/annonc/mdt558. Epub 2014 Jan 7.
The number of long-term survivors after hematopoietic stem cell transplantation (HSCT) showed steady increase in the past two decades. Second malignancies after HSCT are a devastating late complication. We analyzed the incidence of, risk compared with that in the general population, and risk factors for secondary solid cancers.
Patients were 17 545 adult recipients of a first allogeneic stem cell transplantation between 1990 and 2007 in Japan. Risks of developing secondary solid tumors were compared with general population by using standard incidence ratios (SIRs).
Two-hundred sixty-nine secondary solid cancers were identified. The cumulative incidence was 0.7% [95% confidence interval (CI), 0.6%-0.9%] at 5 years and 1.7% (95% CI, 1.4%-1.9%) at 10 years after transplant. The risk was significantly higher than that in the general population (SIR=1.8, 95% CI, 1.5-2.0). Risk was higher for oral cancer (SIR=15.7, 95% CI, 12.1-20.1), esophageal cancer (SIR=8.5, 95% CI, 6.1-11.5), colon cancer (SIR=1.9, 95% CI, 1.2-2.7), skin cancer (SIR=7.2, 95% CI, 3.9-12.4), and brain/nervous system cancer (SIR=4.1, 95% CI, 1.6-8.4). The risk of developing oral, esophageal, or skin cancer was higher at all times after 1-year post-transplant. Extensive-type chronic graft-versus-host disease (GVHD) was a significant risk factor for the development of all solid tumors (RR=1.8, P<0.001), as well as for oral (RR=2.9, P<0.001) and esophageal (RR=5.3, P<0.001) cancers. Limited-type chronic GVHD was an independent risk factor for skin cancers (RR=5.8, P=0.016).
Recipients of allogeneic HSCT had a significantly higher ∼2-fold risk of developing secondary solid cancers than the general population. Lifelong screening for high-risk organ sites, especially oral or esophageal cancers, is important for recipients with active, or a history of, chronic GVHD.
造血干细胞移植（HSCT）后长期存活者的数量在过去二十年中稳步增加。HSCT 后的第二恶性肿瘤是一种毁灭性的晚期并发症。我们分析了继发性实体癌的发病率、与普通人群相比的风险以及危险因素。
1990 年至 2007 年间，日本有 17545 名成年患者接受了首次异基因干细胞移植。通过标准发病率比（SIR）比较发展为继发性实体肿瘤的风险。
共发现 269 例继发性实体癌。移植后 5 年累积发生率为 0.7%（95%CI，0.6%-0.9%），10 年累积发生率为 1.7%（95%CI，1.4%-1.9%）。风险明显高于普通人群（SIR=1.8，95%CI，1.5-2.0）。口腔癌（SIR=15.7，95%CI，12.1-20.1）、食管癌（SIR=8.5，95%CI，6.1-11.5）、结肠癌（SIR=1.9，95%CI，1.2-2.7）、皮肤癌（SIR=7.2，95%CI，3.9-12.4）和脑/神经系统癌（SIR=4.1，95%CI，1.6-8.4）的风险更高。移植后 1 年以上任何时候发生口腔癌、食管癌或皮肤癌的风险均较高。广泛型慢性移植物抗宿主病（GVHD）是所有实体瘤发生的显著危险因素（RR=1.8，P<0.001），也是口腔癌（RR=2.9，P<0.001）和食管癌（RR=5.3，P<0.001）的危险因素。局限性慢性 GVHD 是皮肤癌的独立危险因素（RR=5.8，P=0.016）。
异基因 HSCT 受者发生继发性实体癌的风险显著高于普通人群，约为 2 倍。对于有活动性或有慢性 GVHD 病史的受者，应终生筛查高危器官部位，尤其是口腔或食管癌。
