Lim Wai H, Badve Sunil V, Wong Germaine
Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Oncotarget. 2017 Sep 8;8(44):77771-77782. doi: 10.18632/oncotarget.20781. eCollection 2017 Sep 29.
The excess risk for cancer in kidney transplant recipients is substantial, but the allograft and patient survivals after cancer development are under-studied. This is a population-based cohort study of all primary live and deceased donor kidney transplant recipients in Australia and New Zealand between 1990-2012. The risks of overall graft loss and death with a functioning graft in kidney transplant recipients with and without incident cancer were determined using adjusted Cox regression analysis, with incident cancer considered as a time-varying covariate in the models. In those with incident cancer, types and cancer stage at diagnoses were reported. Of 12,545 transplant recipients followed for a median of 6.9 years (91,380 patient-years), 1184 (9.4%) developed incident cancers at a median of 5.8 years post-transplant. Digestive, kidney and urinary tract cancers were the most common cancer types, although digestive and respiratory tract cancers were more aggressive, with 40% reported as advanced cancers at time of cancer diagnosis. Cancer-related deaths accounted for approximately 80% of recipients with a prior cancer history. Compared with recipients with no prior cancer, the adjusted hazard ratios (HR) for overall graft loss and death with functioning graft were 4.34 (95%CI 3.90, 4.82; p<0.001) and 9.53 (95%CI 8.30, 10.95; <0.001) among those with a prior cancer. Incident cancer after kidney transplantation is a significant risk factor for death with a functioning graft, with the majority of deaths attributed to cancer. A greater understanding of the barriers to screening and treatment approaches following cancer diagnosis may lead to improve survival in kidney transplant recipients with cancer.
肾移植受者患癌症的额外风险很大，但癌症发生后同种异体移植物和患者的生存率研究不足。这是一项基于人群的队列研究，研究对象为1990年至2012年间澳大利亚和新西兰所有原发性活体和已故供体肾移植受者。使用校正后的Cox回归分析确定有和没有新发癌症的肾移植受者中总体移植物丢失和移植肾功能正常时死亡的风险，在模型中将新发癌症视为随时间变化的协变量。在患有新发癌症的患者中，报告了诊断时的癌症类型和癌症分期。在12545名随访中位时间为6.9年（91380患者年）的移植受者中，1184名（9.4%）在移植后中位时间5.8年时发生了新发癌症。消化道、肾脏和泌尿系统癌症是最常见的癌症类型，尽管消化道和呼吸道癌症更具侵袭性，40%的患者在癌症诊断时报告为晚期癌症。癌症相关死亡约占既往有癌症病史受者的80%。与无既往癌症的受者相比，既往有癌症的受者中总体移植物丢失和移植肾功能正常时死亡的校正风险比（HR）分别为4.34（95%CI 3.90, 4.82；p<0.001）和9.53（95%CI 8.30, 10.95；<0.001）。肾移植后新发癌症是移植肾功能正常时死亡的一个重要危险因素，大多数死亡归因于癌症。更好地了解癌症诊断后的筛查障碍和治疗方法可能会提高肾移植癌症患者的生存率。
