Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland.
Department of Medicine, Royal College of Surgeons, Dublin, Ireland.
Nephrol Dial Transplant. 2020 Oct 1;35(10):1802-1810. doi: 10.1093/ndt/gfaa109.
Transplantation is a well-known risk factor for malignancy. However, outcomes of cancer in transplant recipients compared with non-transplant recipients are less well studied. We aim to study the survival in kidney transplant recipients who develop cancer and compare this with cancer outcomes in the general population.
We linked data from the National Cancer Registry Ireland with the National Kidney Transplant Database. The period of observation was from 1 January 1994 until 31 December 2014. Transplant recipients were considered at risk from the time of diagnosing cancer. We administratively censored data at 10 years post-cancer diagnosis. Survival was compared with all patients in the general population that had a recorded diagnosis of cancer.
There were 907 renal transplant recipients and 426679 individuals in the general population diagnosed with cancer between 1 January 1994 and 31 December 2014. In those with non-melanoma skin cancer, the hazard ratio (HR) for 10-year, all-cause mortality [HR = 3.06, 95% confidence interval (CI) 2.66-3.52] and cancer-specific mortality (HR = 3.91, 95% CI 2.57-5.96) was significantly higher among transplant recipients than the general population. Patients who developed non-Hodgkin lymphoma (HR = 2.89, 95% CI 1.96-4.25) and prostate cancer (HR = 4.32, 95% CI 2.39-7.82) had increased all-cause but not cancer-specific mortality. Colorectal, lung, breast and renal cell cancer did not show an increased risk of death in transplant recipients.
Cancer-attributable mortality is higher in kidney transplant recipients with non-melanoma skin cancer compared with non-transplant patients. The American Joint Committee on Cancer staging should reflect the increased hazard of death in these immunosuppressed patients.
移植是恶性肿瘤的一个已知危险因素。然而，与非移植受者相比，移植受者癌症的结果研究得较少。我们旨在研究发生癌症的肾移植受者的生存情况，并将其与普通人群的癌症结果进行比较。
我们将爱尔兰国家癌症登记处的数据与国家肾脏移植数据库相联系。观察期从 1994 年 1 月 1 日至 2014 年 12 月 31 日。从诊断癌症时起，移植受者即被视为有风险。我们将数据在癌症诊断后 10 年进行行政删失。生存情况与普通人群中所有有记录的癌症诊断患者进行比较。
在 1994 年 1 月 1 日至 2014 年 12 月 31 日期间，有 907 例肾移植受者和 426679 例普通人群被诊断患有癌症。在非黑色素瘤皮肤癌患者中，10 年全因死亡率的风险比（HR）[HR=3.06，95%置信区间（CI）2.66-3.52]和癌症特异性死亡率（HR=3.91，95%CI 2.57-5.96）在移植受者中显著高于普通人群。发生非霍奇金淋巴瘤（HR=2.89，95%CI 1.96-4.25）和前列腺癌（HR=4.32，95%CI 2.39-7.82）的患者全因死亡率增加，但癌症特异性死亡率没有增加。结直肠癌、肺癌、乳腺癌和肾细胞癌在移植受者中没有显示出死亡风险增加。
与非移植患者相比，患有非黑色素瘤皮肤癌的肾移植受者的癌症相关死亡率更高。美国癌症联合委员会分期应反映这些免疫抑制患者死亡风险的增加。
