Acuna Sergio A, Huang Johnny W, Daly Corinne, Shah Prakesh S, Kim S Joseph, Baxter Nancy N
1 Institute of Health Policy, Management and Education, University of Toronto, Toronto, ON, Canada. 2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 3 Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada. 4 Departments of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada. 5 Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, ON, Canada. 6 Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Transplantation. 2017 Mar;101(3):471-481. doi: 10.1097/TP.0000000000001192.
Solid organ transplant recipients (SOTR) with a pretransplant malignancy (PTM) are at increased risk for cancer recurrence. However, it is unclear whether differences in survival and incidence of posttransplant de novo malignancies exist between recipients with PTM and those without PTM. We designed a systematic review to synthesize all available evidence assessing these outcomes.
A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies comparing the following outcomes in SOTR by PTM status: (1) all-cause mortality, (2) cancer-specific mortality, and (3) incidence of posttransplant de novo malignancy. Risk of bias was assessed using the Newcastle-Ottawa Scale.
Thirty-two cohort studies were included. Recipients with PTM were at increased risk of all-cause mortality compared to recipients without PTM (pooled hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.27-1.81). Similarly, recipients with PTM were 3 times more likely to die of cancer (pooled HR, 3.13; 95% CI, 2.29-4.27). The pooled HR for developing posttransplant de novo malignancy was also increased (HR, 1.92; 95% CI, 1.52-2.42). The association of all-cause mortality and SOTR with PTM did not vary by transplanted organ.
Pretransplant malignancy is associated with increased risk of all cause-mortality, cancer-specific mortality and of developing de novo malignancies after transplantation compared with those without PTM. These results reaffirm the need for careful selection of transplant recipients with PTM. Tailored screening and management strategies should be developed for this group of patients.
患有移植前恶性肿瘤（PTM）的实体器官移植受者（SOTR）癌症复发风险增加。然而，尚不清楚PTM受者与无PTM受者在移植后新发恶性肿瘤的生存率和发病率方面是否存在差异。我们设计了一项系统评价，以综合评估这些结局的所有现有证据。
在MEDLINE、EMBASE和Cochrane图书馆进行系统检索，以确定按PTM状态比较SOTR以下结局的研究：（1）全因死亡率，（2）癌症特异性死亡率，以及（3）移植后新发恶性肿瘤的发病率。使用纽卡斯尔-渥太华量表评估偏倚风险。
纳入了32项队列研究。与无PTM的受者相比，PTM受者全因死亡风险增加（合并风险比[HR]，1.51；95%置信区间[CI]，1.27-1.81）。同样，PTM受者死于癌症的可能性高出3倍（合并HR，3.13；95%CI，2.29-4.27）。移植后发生新发恶性肿瘤的合并HR也增加了（HR，1.92；95%CI，1.52-2.42）。全因死亡率与PTM的SOTR之间的关联不因移植器官而异。
与无PTM的受者相比，移植前恶性肿瘤与全因死亡率、癌症特异性死亡率以及移植后发生新发恶性肿瘤的风险增加相关。这些结果再次强调了对PTM移植受者进行谨慎选择的必要性。应为这组患者制定针对性的筛查和管理策略。
