Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Department of Epidemiology, University of Iowa, Iowa City, Iowa.
Cancer. 2019 Mar 15;125(6):933-942. doi: 10.1002/cncr.31782. Epub 2019 Jan 9.
Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis.
The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage.
For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall.
For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.
由于免疫抑制药物用于预防器官排斥，移植受者患癌症的风险增加，但作者所知，迄今为止尚无研究全面检查移植状态与癌症诊断后死亡率之间的关系。
作者通过与国家移植登记处（1987-2014 年）的链接，在 11 个癌症登记处确定的美国普通人群中的 16 种不同癌症类型的病例中（n=7147476）。在诊断前（n=11416 例癌症病例）存在实体器官移植的情况通过链接与国家移植登记处确定。使用 Cox 模型来检查移植状态与癌症特异性死亡率之间的关联，调整人口统计学特征和癌症分期。
对于大多数癌症，与其他癌症患者相比，移植受者的癌症特异性死亡率更高。黑色素瘤（调整后的危险比[aHR]，2.59；95%置信区间[95%CI]，2.18-3.00）和乳腺癌（aHR，1.88；95%CI，1.61-2.19）、膀胱癌（aHR，1.85；95%CI，1.58-2.17）和结直肠癌（aHR，1.77；95%CI，1.60-1.96）的增幅尤其明显，但口腔/咽、胃、胰腺、肾脏和肺癌以及弥漫性大 B 细胞淋巴瘤（aHR 范围为 1.21-1.47）的癌症也有所增加。调整首次癌症治疗后，关联仍然显著，并且对于接受潜在治愈性治疗的局部期癌症患者，关联通常更强，包括黑色素瘤（aHR，3.82；95%CI，2.94-4.97）和结直肠癌（aHR，2.77；95%CI，2.07-3.70）、乳腺癌（aHR，2.08；95%CI，1.50-2.88）和前列腺癌（aHR，1.60；95%CI，1.12-2.29）患者，尽管总体上前列腺癌没有关联。
对于多种癌症类型，即使在调整分期和治疗后，患有癌症的移植受者似乎死于癌症的风险增加，这可能是由于免疫受损所致。
