Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada.
Transplant Rev (Orlando). 2017 Oct;31(4):240-248. doi: 10.1016/j.trre.2017.08.003. Epub 2017 Aug 10.
Solid organ transplant recipients (SOTR) with a pre-transplant malignancy (PTM) have been thought to be at high risk of cancer recurrence. However, recent population-based studies report cancer recurrence rates in SOTR similar to those of non-transplant patients. A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies reporting cancer recurrence in SOTR with PTM. Quality assessment was performed using a validated tool for assessing the quality of an observational study with no control group designed by the Institute of Health Economics. Overall and site-specific recurrence rates per person-year were pooled using generalized linear random/mixed-effects meta-analysis models and an exact likelihood approach based on a binomial and Poisson distribution. Meta-regressions, subgroup and sensitivity meta-analyses were used to explore sources of heterogeneity. Fifty-seven eligible studies were identified and 39 were included in the meta-analysis. The pooled recurrence rate was 1.6 (95% CI 1.0-2.6) per 100 person-year for all studies, and 1.1 (95% CI 0.5-2.7) when restricted to population-based studies. The recurrence rate was higher for kidney (2.4 per 100 person-year, 95% CI 1.0-5.6) compared with liver (1.0 per 100 person-year, 95% CI 0.4-2.6), and cardiothoracic recipients (1.3 per 100 person-year, 95% CI 0.6-2.7). Time from cancer diagnosis to transplantation (TCT) ≤ 5 years was associated with greater risk of cancer recurrence compared to TCT > 5 years (risk ratio: 2.80, 95% CI 1.12-7.01). In conclusion, the risk of cancer recurrence in recipients with PTM is considerably lower than historic reports used to establish recommendations for listing patients with PTM. Evidence to support minimum cancer remission times before transplantation is limited.
实体器官移植受者（SOTR）在移植前患有恶性肿瘤（PTM）被认为具有较高的癌症复发风险。然而，最近基于人群的研究报告称，SOTR 的癌症复发率与非移植患者相似。在 MEDLINE、EMBASE 和 Cochrane 图书馆中进行了系统搜索，以确定报告 SOTR 中 PTM 癌症复发的研究。使用卫生经济研究所设计的无对照组观察性研究质量评估工具对质量进行了评估。使用广义线性随机/混合效应荟萃分析模型和基于二项式和泊松分布的精确似然方法，对每 100 人年的总体和特定部位的复发率进行了汇总。使用荟萃回归、亚组和敏感性荟萃分析来探索异质性的来源。确定了 57 项合格的研究，其中 39 项被纳入荟萃分析。所有研究的总体复发率为每 100 人年 1.6（95%CI 1.0-2.6），基于人群的研究限制为每 100 人年 1.1（95%CI 0.5-2.7）。与肝（每 100 人年 1.0，95%CI 0.4-2.6）相比，肾（每 100 人年 2.4，95%CI 1.0-5.6）和心胸受体的复发率更高，而与接受者（每 100 人年 1.3，95%CI 0.6-2.7）。与 TCT>5 年相比，癌症诊断至移植时间（TCT）≤5 年与癌症复发风险增加相关（风险比：2.80，95%CI 1.12-7.01）。总之，PTM 受者的癌症复发风险远低于用于制定 PTM 患者列表建议的历史报告。支持在移植前有最低癌症缓解时间的证据有限。
