爱尔兰器官移植受者头颈部恶性肿瘤的高发病率和死亡率——一项全国队列研究。

Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland.

Am J Otolaryngol. 2023 Jul-Aug;44(4):103827. doi: 10.1016/j.amjoto.2023.103827. Epub 2023 Mar 9.

BACKGROUND

Solid organ transplant recipients are recognized to carry a high burden of malignancy and frequently this cancer develops in the head and neck region. Furthermore, cancer of the head and neck post-transplant carries a significantly increased mortality. In this study, we aim to conduct a national retrospective cohort study to investigate the impact of head and neck cancer in terms of frequency and mortality in a large group of solid organ transplant recipients over a 20 year time span and compare the mortality in transplant patients to non-transplant patients with head and neck cancer.

METHODS

Patients in the Republic of Ireland who underwent solid organ transplantation between 1994 and 2014 who developed post-transplant head and neck malignancy were identified from the records of two prospective, national databases (National Cancer Registry of Ireland (NCRI) and The Irish Transplant Cancer Group database) working in conjunction with each other. Incidence of head and neck malignancy post-transplant was compared with the general population by means of standardised incidence ratios (SIR). Cumulative incidence of all cause and cancer related mortality from head and neck keratinocytic was undertaken by a competing risks analysis.

RESULTS

A total of 3346 solid organ transplant recipients were identified, 2382 (71.2 %) kidney, 562 (16.8 %) liver, 214 (6.4 %) cardiac and 188 (5.6 %) lung. During the period of follow up of 428 patients developed head and neck cancer, representing (12.8 %) of the population. 97 % of these patients developed keratinocytic cancers, specifically, of head and neck. The frequency of post-transplant head and neck cancer was related to the duration of immunosuppression with 14 % of patients developing cancer at 10 years and 20 % having developed at least one cancer by 15 years. 12 (3 %) patients developed non-cutaneous head and neck malignancy. 10 (0.3 %) patients died due to head and neck keratinocytic malignancy post-transplant. Competing risk analysis demonstrated that organ transplantation conferred a strong independent effect of death, compared to non-transplant patients with head and neck keratinocytes. This applied specifically for kidney (HR 4.4, 95 % CI 2.5-7.8) and heart transplants (HR 6.5, 95 % CI 2.1-19.9), and overall, across the four transplant categories (P < 0.001). The SIR of developing keratinocyte cancer varied based on primary tumor site, gender, and type of transplant organ.

CONCLUSION

Transplant patients demonstrate a particularly high rate of head and neck keratinocyte cancer with a very high rate of associated mortality. Physicians should be cognizant of the increased rate of malignancy in this population and monitor for red flag signs/symptoms.

背景

实体器官移植受者被认为患有高度恶性肿瘤，并且这种癌症通常发生在头颈部。此外，移植后头颈部癌症的死亡率显著增加。在这项研究中，我们旨在开展一项全国性回顾性队列研究，以调查在 20 年的时间跨度内，大量实体器官移植受者中头颈部癌症的发生频率和死亡率，并将移植患者与非移植患者的头颈部癌症死亡率进行比较。

方法

通过两个相互配合的全国性前瞻性数据库（爱尔兰国家癌症登记处（NCRI）和爱尔兰移植癌症组数据库）的记录，确定 1994 年至 2014 年间接受实体器官移植后出现移植后头颈部恶性肿瘤的爱尔兰共和国患者。通过标准化发病率比（SIR）比较移植后头颈部恶性肿瘤的发病率与普通人群。通过竞争风险分析评估头颈部角质形成细胞癌的全因和癌症相关死亡率的累积发生率。

结果

共确定了 3346 名实体器官移植受者，其中 2382 名（71.2%）为肾脏，562 名（16.8%）为肝脏，214 名（6.4%）为心脏，188 名（5.6%）为肺部。在 428 名患者的随访期间，有 428 名患者发生了头颈部癌症，占患者总数的 12.8%。这些患者中 97%患有角质形成细胞癌，具体而言，是头颈部的癌症。移植后头颈部癌症的频率与免疫抑制的持续时间有关，14%的患者在 10 年内发生癌症，20%的患者在 15 年内至少发生了一种癌症。12 名（3%）患者发生非皮肤头颈部恶性肿瘤。10 名（0.3%）患者因移植后头颈部角质形成细胞癌而死亡。竞争风险分析表明，与非移植患者相比，器官移植对头颈部角质形成细胞的死亡有很强的独立影响。这具体适用于肾脏（HR 4.4，95%CI 2.5-7.8）和心脏移植（HR 6.5，95%CI 2.1-19.9），以及总体而言，在四个移植类别中（P<0.001）。发生角质形成细胞癌的 SIR 基于原发肿瘤部位、性别和移植器官类型而有所不同。