Karami S, Yanik E L, Moore L E, Pfeiffer R M, Copeland G, Gonsalves L, Hernandez B Y, Lynch C F, Pawlish K, Engels E A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, MD.
Michigan Cancer Surveillance Program, Michigan Department of Community Health, Lansing, MI.
Am J Transplant. 2016 Dec;16(12):3479-3489. doi: 10.1111/ajt.13862. Epub 2016 Jun 23.
Renal cell carcinoma (RCC) is a common malignancy following kidney transplantation. We describe RCC risk and examine RCC risk factors among US kidney recipients (1987-2010). The Transplant Cancer Match Study links the US transplant registry with 15 cancer registries. Standardized incidence ratios (SIRs) were used to compare RCC risk (overall and for clear cell [ccRCC] and papillary subtypes) to the general population. Associations with risk factors were assessed using Cox models. We identified 683 RCCs among 116 208 kidney recipients. RCC risk was substantially elevated compared with the general population (SIR 5.68, 95% confidence interval 5.27-6.13), especially for papillary RCC (SIR 13.3 versus 3.98 for ccRCC). Among kidney recipients, RCC risk was significantly elevated for blacks compared to whites (hazard ratio [HR] 1.50) and lower in females than males (HR 0.56). RCC risk increased with prolonged dialysis preceding transplantation (p-trend < 0.0001). Risk was variably associated for RCC subtypes with some medical conditions that were indications for transplantation: ccRCC risk was reduced with polycystic kidney disease (HR 0.54), and papillary RCC was increased with hypertensive nephrosclerosis (HR 2.02) and vascular diseases (HR 1.86). In conclusion, kidney recipients experience substantially elevated risk of RCC, especially for papillary RCC, and multiple factors contribute to these cancers.
肾细胞癌（RCC）是肾移植后常见的恶性肿瘤。我们描述了美国肾移植受者（1987 - 2010年）中RCC的风险并研究了其风险因素。移植癌症匹配研究将美国移植登记处与15个癌症登记处相联系。标准化发病比（SIR）用于比较RCC风险（总体以及透明细胞型[ccRCC]和乳头状亚型）与一般人群的风险。使用Cox模型评估与风险因素的关联。我们在116208名肾移植受者中识别出683例RCC。与一般人群相比，RCC风险显著升高（SIR 5.68，95%置信区间5.27 - 6.13），尤其是乳头状RCC（SIR 13.3，而ccRCC为3.98）。在肾移植受者中，黑人的RCC风险相比白人显著升高（风险比[HR] 1.50），女性低于男性（HR 0.56）。RCC风险随着移植前透析时间延长而增加（p趋势<0.0001）。RCC亚型的风险与一些作为移植指征的疾病状况存在不同关联：ccRCC风险在多囊肾病患者中降低（HR 0.54），而乳头状RCC在高血压性肾硬化（HR 2.02）和血管疾病患者中升高（HR 1.86）。总之，肾移植受者患RCC的风险显著升高，尤其是乳头状RCC，多种因素促成了这些癌症的发生。
