Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy.
Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
Int J Cancer. 2018 Oct 1;143(7):1588-1594. doi: 10.1002/ijc.31552. Epub 2018 May 10.
This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person-years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow-up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8-fold higher cancer risk (95% CI: 1.6-2.0). SIRs were particularly elevated for virus-related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0-88.5), non-Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8-10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1-15.8). Among virus-unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1-6.2), esophagus (SIR = 6.7, 95% CI: 2.9-13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8-82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0-2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0-5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0-0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients.
本队列研究评估了意大利肝移植（LT）后新发恶性肿瘤的整体风险模式。研究组纳入了 1985 年至 2014 年间在意大利九个中心接受 LT 的 2832 名个体。癌症风险的人年（PYs）从 LT 后 30 天开始计算，直至癌症诊断日期、死亡日期或随访结束日期。使用标准化发病率比（SIRs）和 95%置信区间（CIs）来估计与普通人群相比的癌症超额风险。在 18642 人年中，246 名 LT 受者发生了 266 例新发恶性肿瘤，癌症风险增加了 1.8 倍（95%CI：1.6-2.0）。病毒相关性恶性肿瘤的 SIR 特别高，包括卡波西肉瘤（SIR=53.6，95%CI：30.0-88.5）、非霍奇金淋巴瘤（SIR=7.1，95%CI：4.8-10.1）和子宫颈（SIR=5.4，95%CI：1.1-15.8）。在与病毒无关的恶性肿瘤中，头颈部（SIR=4.4，95%CI：3.1-6.2）、食管（SIR=6.7，95%CI：2.9-13.3）和肾上腺（SIR=22.9，95%CI：2.8-82.7）的风险升高。肺癌（SIR=1.4，95%CI：1.0-2.1）和皮肤黑色素瘤（SIR=2.6，95%CI：1.0-5.3）的风险也略有统计学意义升高。前列腺癌（SIR=0.1，95%CI：0.0-0.5）的风险降低。这些发现强调了需要针对 LT 受者量身定制预防干预和早期检测恶性肿瘤。
