美国实体器官移植受者的癌症相关死亡率：1987 年至 2014 年。
Cancer-attributable mortality among solid organ transplant recipients in the United States: 1987 through 2014.
机构信息
Divison of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Divison of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
出版信息
Cancer. 2019 Aug 1;125(15):2647-2655. doi: 10.1002/cncr.32136. Epub 2019 Apr 29.
BACKGROUND
Solid organ transplant recipients have an elevated risk of cancer. Quantifying deaths attributable to cancer can inform priorities to reduce cancer burden.
METHODS
Linked transplantation and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987-2014). Population-attributable fractions (PAFs) of deaths due to cancer and corresponding cancer-attributable mortality rates were estimated using Cox models.
RESULTS
Among 221,962 solid organ transplant recipients, 15,012 developed cancer. Approximately 13% of deaths (PAF, 13.2%) were attributable to cancer, corresponding to a cancer-attributable mortality rate of 516 per 100,000 person-years. Lung cancer was the largest contributor to mortality (PAF, 3.1%), followed by non-Hodgkin lymphoma (NHL; PAF, 1.9%), colorectal cancer (PAF, 0.7%), and kidney cancer (PAF, 0.5%). Cancer-attributable mortality rates increased with age at transplantation, reaching 1229 per 100,000 person-years among recipients aged ≥65 years. NHL was the largest contributor among children (PAF, 4.1%) and lung cancer was the largest contributor among recipients aged ≥50 years (PAFs, 3.7%-4.3%). Heart recipients had the highest PAF (16.4%), but lung recipients had the highest cancer-attributable mortality rate (1241 per 100,000 person-years). Overall, mortality attributable to cancer increased steadily with longer time since transplantation, reaching 15.7% of deaths (810 per 100,000 person-years) at ≥10 years after transplantation. Comparison of cancer-attributable mortality rates with specified causes of death indicated that some deaths recorded as other causes might instead be caused by cancer or its treatment.
CONCLUSIONS
Cancer is a substantial cause of mortality among solid organ transplant recipients, with major contributions reported from lung cancer and NHL. Cancer-attributable mortality increases with age and time since transplantation, and therefore cancer deaths will become an increasing burden as recipients live longer.
背景
实体器官移植受者的癌症风险增加。量化癌症导致的死亡人数可以为降低癌症负担提供信息。
方法
使用美国的移植和癌症登记处的数据，确定了 1987 年至 2014 年间实体器官移植受者的新发癌症和死亡人数。使用 Cox 模型估计癌症导致的死亡的人群归因分数（PAF）和相应的癌症归因死亡率。
结果
在 221962 名实体器官移植受者中，有 15012 人患有癌症。约 13%的死亡（PAF，13.2%）归因于癌症，相应的癌症归因死亡率为每 10 万人 516 人。肺癌是导致死亡的最大因素（PAF，3.1%），其次是非霍奇金淋巴瘤（NHL；PAF，1.9%）、结直肠癌（PAF，0.7%）和肾癌（PAF，0.5%）。癌症归因死亡率随移植时年龄的增加而增加，年龄≥65 岁的受者达到每 10 万人 1229 人。NHL 是儿童中最大的贡献者（PAF，4.1%），肺癌是≥50 岁受者中最大的贡献者（PAF，3.7%-4.3%）。心脏受者的 PAF 最高（16.4%），但肺癌受者的癌症归因死亡率最高（每 10 万人 1241 人）。总的来说，随着移植后时间的延长，癌症导致的死亡人数稳步增加，移植后≥10 年时达到 15.7%（每 10 万人 810 人）。与特定死因的癌症归因死亡率进行比较表明，一些记录为其他原因的死亡可能是由癌症或其治疗引起的。
结论
癌症是实体器官移植受者死亡的一个重要原因，肺癌和 NHL 报告了主要贡献。癌症归因死亡率随年龄和移植后时间的增加而增加，因此随着受者寿命的延长，癌症死亡将成为越来越大的负担。
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