Operative Unit of Nephrology, ASST Spedali Civili, Brescia, Italy.
Clinical Epidemiology Unit - Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, via Portuense 292, 00149, Rome, Italy.
J Nephrol. 2017 Dec;30(6):851-857. doi: 10.1007/s40620-017-0385-y. Epub 2017 Mar 19.
Kidney transplant recipients (KTR) are known to have a higher risk of cancer than the general population, especially of malignancies related to oncogenic viral infections. This study assessed the incidence of de novo malignancies (DNMs) in patients receiving kidney transplantation and in dialysis patients (DP) on the waiting list for transplantation at the same centre. The aim was to quantify the contribution of post-transplant immunosuppression to the underlying risk of developing a DNM in dialysis patients on the waiting list for kidney transplant.
Cancer incidence rates were computed using the Kaplan-Meier product-limit method. The number of DNMs observed in both groups was compared to the expected incidence in the general Italian population through calculation of the standardized incidence ratios (SIR) and their 95% confidence intervals (CI). To identify risk factors, incidence rate ratios (IRR) and 95% CIs were computed using Poisson regression analysis. The comparison of incidence rates between the two cohorts was also performed using age standardized incidence rates (ASR) and their ratio (age standardized rate ratio, ASRR).
In 4858 person-years (PYs) of observation, 75 out of 735 KTR were diagnosed with DNM: 57 solid neoplasms, 13 post-transplant lymphoproliferative disorders (PTLD), and 12 Kaposi sarcomas (KS). The overall incidence was 17.5 cases/10 PYs, resulting in a 2.1-fold increased risk. Twenty-four out of 912 DP, over a follow-up of 2400 PYs, were diagnosed with a solid neoplasm, but none had PTLD or KS. The use of induction therapy after transplant was associated with a significant increased risk of KS (IRR: 3.52; 95% CI 1.04-11.98, p < 0.05). ASRR for all cancers and for solid cancers only was 1.84- and 1.19-fold higher in KTR, respectively, than in the general population. The overall incidence in DP was 10.0 cases/10 PYs, with a 1.6 significantly increased cancer risk compared to the general population.
Our study confirms the increased risk of cancer after transplantation and during dialysis, but showed that virus-related cancers only occur after post-transplant immunosuppression.
肾移植受者（KTR）的癌症风险高于普通人群，尤其是与致癌病毒感染相关的恶性肿瘤。本研究评估了同一中心接受肾移植的患者和等待移植的透析患者（DP）新发恶性肿瘤（DNM）的发生率。目的是量化移植后免疫抑制对透析患者等待肾移植时发生 DNM 的潜在风险的贡献。
使用 Kaplan-Meier 乘积限法计算癌症发生率。通过计算标准化发病率比（SIR）及其 95%置信区间（CI），比较两组中观察到的 DNM 数量与意大利普通人群的预期发病率。使用泊松回归分析计算发病率比（IRR）及其 95%CI，以确定危险因素。使用年龄标准化发病率（ASR）及其比值（年龄标准化率比，ASRR）比较两组的发病率。
在 4858 人年（PY）的观察期内，735 名 KTR 中有 75 名被诊断患有 DNM：57 例实体瘤、13 例移植后淋巴组织增生性疾病（PTLD）和 12 例卡波西肉瘤（KS）。总发病率为 17.5 例/10 PY，风险增加 2.1 倍。912 名 DP 中有 24 名在随访 2400 PY 后被诊断为实体瘤，但无一例患有 PTLD 或 KS。移植后使用诱导治疗与 KS 的显著高风险相关（IRR：3.52；95%CI 1.04-11.98，p<0.05）。KTR 中所有癌症和实体癌的 ASRR 分别比普通人群高 1.84 倍和 1.19 倍。DP 的总发病率为 10.0 例/10 PY，与普通人群相比，癌症风险显著增加 1.6 倍。
本研究证实了移植后和透析期间癌症风险增加，但表明病毒相关癌症仅在移植后免疫抑制后发生。
