Sułowicz Joanna, Wojas-Pelc Anna, Ignacak Ewa, Betkowska-Prokop Alina, Kuzniewski Marek, Sułowicz Władysław
Przegl Lek. 2014;71(1):19-25.
Non melanoma skin cancers (NMSC) represent a major challenge within the ever growing group of different organs recipients. The aim of the study was to evaluate risk factors influencing on frequency appearance of NMSC in patients after kidney transplantation. The clinical dermatological examination was performed in 486 patients after kidney transplantation consisted of 296 man (60.9%) and 190 woman (30.1%) in the mean age 46.1 +/- 13.1 (18-74 years) with median time after transplantation 74.3 +/- 52.1 months. Most of them (80.7%) before transplantation were treated by maintenance hemodialysis. Patients after kidney transplantation were checked by dermatologist for all skin abnormalities based on iniciated skin cancers screening program. All discovered abnormalities were described, their type, size, localization and results of histopathological examination were collected. The obtained results were analyzed based on t-Student's, Mann-Whitney's, chi-square and Fisher tests. Out of 486 studied patients, 53 NMSC were diagnosed in 25 kidney recipients including 39 basal cell carcinoma (BCC), 13 squamous cell carcinoma (SCC) and 1 Bowen's disease. The proportion of BCC to SCC was 2.79. NMSC occurred more often on sun skin exposure area, especially on the face. Almost all (96.2%) of the cancers were diagnosed in patients older than 50 years of age. Patients with NMSC comparing with those without were significantly older (52.8 +/- 7.8 vs. 41.0 +/- 7.8; p < 0.0001), have longer post-transplant period and have more frequent positive anamnesis of this cancer. There was no significant relationship between NMSC appearance and sex, cause of kidney failure, HLA mismatch, blood group as well as Rh factor.
Older age of patients while transplantation, longer time of immunosuppressive therapy and previous NMSC are independent predictors of new skin cancers appearance.
非黑色素瘤皮肤癌(NMSC)是器官移植受者群体不断扩大所面临的一项重大挑战。本研究旨在评估影响肾移植患者NMSC发生频率的危险因素。对486例肾移植患者进行了临床皮肤科检查,其中男性296例(60.9%),女性190例(30.1%),平均年龄46.1±13.1岁(18 - 74岁),移植后中位时间为74.3±52.1个月。他们中的大多数(80.7%)移植前接受维持性血液透析治疗。根据启动的皮肤癌筛查计划,皮肤科医生对肾移植患者的所有皮肤异常情况进行检查。对所有发现的异常情况进行描述,收集其类型、大小、部位及组织病理学检查结果。基于t检验、曼 - 惠特尼检验、卡方检验和费舍尔检验对所得结果进行分析。在486例研究患者中,25例肾移植受者被诊断出53例NMSC,其中包括39例基底细胞癌(BCC)、13例鳞状细胞癌(SCC)和1例鲍恩病。BCC与SCC的比例为2.79。NMSC更常发生于阳光暴露部位,尤其是面部。几乎所有(96.2%)的癌症在50岁以上患者中被诊断出来。与未患NMSC的患者相比,患NMSC的患者年龄显著更大(52.8±7.8岁对41.0±7.8岁;p < 0.0001),移植后时间更长,且该癌症既往史更常见。NMSC的发生与性别、肾衰竭病因、HLA错配、血型以及Rh因子之间无显著关系。
移植时患者年龄较大、免疫抑制治疗时间较长以及既往有NMSC是新发皮肤癌出现的独立预测因素。