Division of Rheumatology, Department of Medicine , Feinberg School of Medicine, Northwestern University , Chicago, Illinois , USA.
Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
Lupus Sci Med. 2016 Jun 6;3(1):e000156. doi: 10.1136/lupus-2016-000156. eCollection 2016.
We investigated malignancy risk after renal transplantation in patients with and without systemic lupus erythematosus (SLE).
Using the United States Renal Data System from 2001 to 2009, 143 652 renal transplant recipients with and without SLE contributed 585 420 patient-years of follow-up to determine incident cancers using Medicare claims codes. We calculated standardised incidence ratios (SIRs) of cancer by group using age, sex, race/ethnicity-specific and calendar year-specific cancer rates compared with the US population.
10 160 cancers occurred at least 3 months after renal transplant. Overall cancer risk was increased in both SLE and non-SLE groups compared with the US general population, SIR 3.5 (95% CI 2.1 to 5.7) and SIR 3.7 (95% CI 2.4 to 5.7), respectively. Lip/oropharyngeal, Kaposi, neuroendocrine, thyroid, renal, cervical, lymphoma, liver, colorectal and breast cancers were increased in both groups, whereas only melanoma was increased in SLE and lung cancer was increased in non-SLE. In Cox regression analysis, SLE status (HR 1.1, 95% CI 0.9 to 1.3) was not associated with increased risk of developing cancer, adjusted for other independent risk factors for developing cancer in renal transplant recipients. We found that smoking (HR 2.2, 95% CI 1.2 to 4.0), cytomegalovirus positivity at time of transplant (HR 1.3, 95% CI 1.2 to 1.4), white race (HR 1.2, 95% CI 1.2 to 1.3) and older recipient age at time of transplantation (HR 1.0 95% CI 1.0 to 1.2) were associated with an increased risk for development of cancer, whereas shorter time on dialysis, Epstein-Barr virus or HIV were associated with a lower risk for development of cancer.
Cancer risk in renal transplant recipients appeared similar in SLE and non-SLE subjects, aside from melanoma. Renal transplant recipients may need targeted counselling regarding surveillance and modifiable risk factors.
我们研究了红斑狼疮（SLE）患者和非 SLE 患者肾移植后发生恶性肿瘤的风险。
利用美国肾脏数据系统（2001 年至 2009 年），143652 例肾移植患者（伴或不伴 SLE）共随访 585420 患者年，使用医疗保险索赔代码确定癌症的发病情况。我们根据年龄、性别、种族/民族特异性和日历年份特异性癌症发病率，用与美国人群相比的标准化发病比（SIR）来计算癌症的发病率。
肾移植后至少 3 个月发生了 10160 例癌症。与美国普通人群相比，SLE 组和非 SLE 组的总体癌症风险均增加，SIR 分别为 3.5（95%CI 2.1 至 5.7）和 3.7（95%CI 2.4 至 5.7）。两组均增加了唇/口咽、卡波西肉瘤、神经内分泌、甲状腺、肾、宫颈、淋巴瘤、肝、结直肠和乳腺癌，而 SLE 组仅增加了黑色素瘤，非 SLE 组仅增加了肺癌。在 Cox 回归分析中，SLE 状态（HR 1.1，95%CI 0.9 至 1.3）与肾移植受者发生癌症的风险增加无关，这是在调整了其他独立的癌症发生危险因素后得出的。我们发现，吸烟（HR 2.2，95%CI 1.2 至 4.0）、移植时巨细胞病毒阳性（HR 1.3，95%CI 1.2 至 1.4）、白种人（HR 1.2，95%CI 1.2 至 1.3）和移植时受者年龄较大（HR 1.0，95%CI 1.0 至 1.2）与癌症发病风险增加相关，而透析时间较短、EB 病毒或 HIV 与癌症发病风险降低相关。
除黑色素瘤外，SLE 患者和非 SLE 患者肾移植后的癌症风险似乎相似。肾移植受者可能需要针对监测和可改变的风险因素进行有针对性的咨询。
