Institute of Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada2Department of Surgery, Li Ki Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
JAMA Oncol. 2016 Apr;2(4):463-9. doi: 10.1001/jamaoncol.2015.5137.
Solid-organ transplant recipients (SOTRs) are at greater risk of developing some cancers than the general population; however, because they are also at increased risk of mortality from noncancer causes, the effect of transplantation on cancer mortality is unclear.
To describe cancer mortality in SOTRs and to assess whether SOTRs are at increased risk of cancer mortality compared with the general population.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study of patients who underwent solid-organ transplantation in Ontario, Canada, between 1991 and 2010 with 85 557 person-years of follow-up through December 31, 2011. Solid-organ transplantation was identified using the national transplant register and linked to the provincial cancer registry and administrative databases. The analysis was conducted between November 2013 and February 2015.
Solid-organ transplantation.
Cancer mortality for SOTRs was compared with that of the general population using standardized mortality ratios (SMRs). Mortality and cause of death were ascertained by record linkage between the Canadian Organ Replacement Register, the Ontario Cancer Registry, and the Office of the Registrar General of Ontario death database.
A total of 11 061 SOTRs were identified, including 6516 kidney, 2606 liver, 929 heart, and 705 lung transplantations. Recipients had a median (interquartile range) age of 49 (37-58) years, and 4004 (36.2%) were women. Of 3068 deaths, 603 (20%) were cancer related. Cancer mortality in SOTRs was significantly elevated compared with the Ontario population (SMR, 2.84 [95% CI, 2.61-3.07]). The risk remained elevated when patients with pretransplant malignant neoplasms (n = 1124) were excluded (SMR, 1.93 [95% CI, 1.75-2.13]). The increased risk was observed irrespective of transplanted organ. The SMR for cancer death after solid-organ transplantation was higher in children (SMR, 84.61 [95% CI, 52.00-128.40]) and lower in patients older than 60 years (SMR, 1.88 [95% CI, 1.62-2.18]) but remained elevated compared with the general population at all ages.
Cancer death rate in SOTRs was increased compared with that expected in the general population; cancer was the second leading cause of death in these patients. Advances in prevention, clinical surveillance, and cancer treatment modalities for SOTRs are needed to reduce the burden of cancer mortality in this population.
实体器官移植受者（SOTR）患某些癌症的风险高于一般人群；然而，由于他们死于非癌症原因的风险也增加，因此移植对癌症死亡率的影响尚不清楚。
描述 SOTR 的癌症死亡率，并评估与一般人群相比，SOTR 是否有更高的癌症死亡风险。
设计、地点和参与者：这是一项基于人群的队列研究，纳入了 1991 年至 2010 年间在加拿大安大略省接受实体器官移植的患者，随访时间为 85557 人年，截至 2011 年 12 月 31 日。使用国家移植登记处识别实体器官移植，并与省级癌症登记处和行政数据库相联系。分析于 2013 年 11 月至 2015 年 2 月进行。
实体器官移植。
使用标准化死亡率比（SMR）比较 SOTR 的癌症死亡率与一般人群的死亡率。通过加拿大器官替代登记处、安大略癌症登记处和安大略省注册主任办公室死亡数据库之间的记录链接确定死亡率和死因。
共确定了 11061 名 SOTR，包括 6516 例肾脏、2606 例肝脏、929 例心脏和 705 例肺移植。患者的中位（四分位间距）年龄为 49（37-58）岁，其中 4004 名（36.2%）为女性。在 3068 例死亡中，603 例（20%）与癌症有关。与安大略省人群相比，SOTR 的癌症死亡率显著升高（SMR，2.84 [95%CI，2.61-3.07]）。排除移植前恶性肿瘤患者（n=1124）后，风险仍然升高（SMR，1.93 [95%CI，1.75-2.13]）。无论移植的器官如何，这种风险都存在。与一般人群相比，儿童（SMR，84.61 [95%CI，52.00-128.40]）和 60 岁以上患者（SMR，1.88 [95%CI，1.62-2.18]）的癌症死亡 SMR 更高，但在所有年龄段仍然高于一般人群。
与一般人群相比，SOTR 的癌症死亡率增加；癌症是这些患者的第二大死亡原因。需要在 SOTR 中推进预防、临床监测和癌症治疗方法，以降低该人群的癌症死亡率负担。
