Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
Am J Transplant. 2023 Feb;23(2):257-264. doi: 10.1016/j.ajt.2022.11.006. Epub 2023 Jan 12.
Little is known about the outcomes among solid organ transplant recipients with a pretransplant cancer diagnosis. We used linked data from the Scientific Registry of Transplant Recipients with 33 US cancer registries. Cox proportional hazards models assessed associations of pretransplant cancer with overall mortality, cancer-specific mortality, and development of a new posttransplant cancer. Among 311 677 recipients, the presence of a single pretransplant cancer was associated with increased overall mortality (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.15-1.23) and cancer-specific mortality (aHR, 1.93; 95% CI, 1.76-2.12); results for 2+ pretransplant cancers were similar. Cancer-specific mortality was not significantly increased for uterine, prostate, or thyroid cancers (aHRs were 0.83, 1.22, and 1.54, respectively) but strongly elevated for lung cancer and myeloma (aHRs were 3.72 and 4.42, respectively). A pretransplant cancer diagnosis was also associated with increased risk of developing posttransplant cancer (aHR, 1.32; 95% CI, 1.23-1.40). Among 306 recipients whose cancer death was confirmed by cancer registry data, 158 deaths (51.6%) were from a de novo posttransplant cancer and 105 (34.3%) from the pretransplant cancer. Pretransplant cancer diagnoses are associated with increased mortality after transplantation, but some deaths are related to posttransplant cancers and other causes. Improved candidate selection and cancer screening and prevention may reduce mortality in this population.
对于接受实体器官移植的患者，其在移植前患有癌症的情况下的结局知之甚少。我们使用了来自美国 33 个癌症登记处的科学移植受者登记处的相关数据。Cox 比例风险模型评估了移植前癌症与全因死亡率、癌症特异性死亡率和新发生的移植后癌症之间的关联。在 311677 名受者中，单个移植前癌症的存在与全因死亡率（校正后风险比 [aHR]，1.19；95%CI，1.15-1.23）和癌症特异性死亡率（aHR，1.93；95%CI，1.76-2.12）显著升高相关；存在 2 个及以上移植前癌症的结果类似。子宫、前列腺或甲状腺癌的癌症特异性死亡率并未显著升高（aHR 分别为 0.83、1.22 和 1.54），但肺癌和骨髓瘤的癌症特异性死亡率显著升高（aHR 分别为 3.72 和 4.42）。移植前癌症诊断与发生移植后癌症的风险增加相关（aHR，1.32；95%CI，1.23-1.40）。在 306 名癌症死亡经癌症登记数据证实的受者中，158 例（51.6%）死亡归因于新发生的移植后癌症，105 例（34.3%）归因于移植前癌症。移植前癌症诊断与移植后死亡率增加相关，但部分死亡与移植后癌症和其他原因有关。改进候选者选择和癌症筛查及预防可能会降低该人群的死亡率。
