Park Marn Joon, Roh Jong-Lyel, Choi Seung-Ho, Nam Soon Yuhl, Kim Sang Yoon, Lee Yoon Se
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Auris Nasus Larynx. 2018 Aug;45(4):838-845. doi: 10.1016/j.anl.2017.11.006. Epub 2017 Nov 14.
De novo cancers of head and neck area in solid organ transplantation recipients show standardized incidence ratio (SIR) of 3.8. Immunosuppression following transplantation is suggested to play as a crucial factor in pathogenesis of secondary malignancy. Prognosis of head and neck cancer arising in solid organ transplantation recipients is proven to have poor prognosis. The incidence, risk, prognosis, and survival of de novo malignancy of head and neck area in solid organ transplantation recipients in single-tertiary medical center followed up for 20 years.
A retrospective medical record review of the patients who received solid organ transplantation in Asan Medical Center from 1997 to 2016 was conducted. Patients confirmed as de novo malignancy in the head and neck area after organ transplantation were included, and presented as in the case-series format. Patients with previous history of head and neck malignancy, irradiation history of head and neck area, cutaneous malignant lesion, hematopoietic malignant lesion, malignancy of thyroid and parathyroid gland and metastatic lesions newly developed in head and neck area were excluded. The incidence of head and neck malignancy in South Korea were reviewed from the National Cancer Information Center of South Korea. For the statistical analysis, standardized incidence ratio (SIR) was obtained with 95% confidence interval.
Solid organ transplantation recipients show 20 times higher incidence of de novo cancer of head and neck area compared to general population. Of 13 de novo head and neck malignancy arising after solid organ transplantation, 2 (15.4%) patients were unable to withstand definitive management due to poor general condition. 2 (15.4%) patients had loco-regional recurrence, 1 (7.7%) patient with distant metastasis, and 3 (23.1%) patients died of cancer progression.
Immunosuppression following solid organ transplantation gives a twenty-fold increased risk for the development of de novo head and neck cancer. A more precise and frequent checkup on head and area should be planned, suggesting a multi-disciplinary approach in combination with organ transplantation team.
实体器官移植受者头颈部新发癌症的标准化发病比（SIR）为3.8。移植后的免疫抑制被认为是继发性恶性肿瘤发病机制中的关键因素。实体器官移植受者中发生的头颈部癌症预后较差。对单一三级医疗中心随访20年的实体器官移植受者头颈部新发恶性肿瘤的发病率、风险、预后和生存率进行研究。
对1997年至2016年在峨山医疗中心接受实体器官移植的患者进行回顾性病历审查。纳入器官移植后被确诊为头颈部新发恶性肿瘤的患者，并以病例系列形式呈现。排除既往有头颈部恶性肿瘤病史、头颈部放疗史、皮肤恶性病变、血液系统恶性病变、甲状腺和甲状旁腺恶性肿瘤以及头颈部新出现的转移病变的患者。从韩国国家癌症信息中心查阅韩国头颈部恶性肿瘤的发病率。进行统计分析时，获得标准化发病比（SIR）及其95%置信区间。
实体器官移植受者头颈部新发癌症的发病率比普通人群高20倍。在实体器官移植后出现的13例头颈部新发恶性肿瘤中，2例（15.4%）患者因全身状况差无法耐受确定性治疗。2例（15.4%）患者出现局部区域复发，1例（7.7%）患者发生远处转移，3例（23.1%）患者死于癌症进展。
实体器官移植后的免疫抑制使头颈部新发癌症的发生风险增加20倍。应计划对头颈部进行更精确和频繁的检查，建议采用多学科方法并联合器官移植团队。
