Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia.
Int J Cancer. 2020 May 15;146(10):2703-2711. doi: 10.1002/ijc.32585. Epub 2019 Aug 23.
Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013. Date of death and underlying cause of death were ascertained by data-linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person-years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all-site (SMR 2.9, 95% CI 2.7-3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5-59.6) and lymphoma (SMR 42.2, 95% CI 35.3-50.5). Relative cancer mortality decreased with increasing age in men (p < 0.001) and women (p = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (p-value >0.1). Only relative colorectal cancer mortality increased over time (p = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.
在接受肾移植的患者中，癌症负担正在增加，但与普通人群相比，死亡率的差异仍不清楚。我们旨在比较儿童和成年肾移植受者与普通人群的癌症死亡率，并描述按部位、年龄和性别、国家和时间的任何差异。我们纳入了澳大利亚和新西兰透析和移植登记处 1980-2013 年的肾移植受者。通过数据链接确定死亡日期和死因，并使用 ICD10AM 代码进行分类。使用间接标准化来估计标准化死亡率比（SMR）。在 175084 人年的观察期内，有 17628 例肾移植受者中有 5284 例死亡，包括 1061 例（20%）癌症死亡。所有部位（SMR2.9，95%CI2.7-3.1）的癌症相对死亡率均高于普通人群，非黑素瘤皮肤癌（SMR50.9，95%CI43.5-59.6）和淋巴瘤（SMR42.2，95%CI35.3-50.5）的相对死亡率最高。男性（p<0.001）和女性（p=0.001）的相对癌症死亡率随年龄的增加而降低，但从未与普通人群相等。皮肤和嘴唇或结直肠癌的相对死亡率随年龄变化而无变化（p 值>0.1）。只有相对结直肠癌死亡率随时间增加（p=0.002）。我们的研究表明，肾移植受者的癌症死亡率高于普通人群的预期。超额死亡率的幅度因癌症部位、年龄和性别而异。需要进一步的证据来确定这种差异是否是由于诊断时的差异或该人群中癌症治疗的获得和有效性所致。
