Cicalese Luca, Westra Jordan R, O'Connor Casey M, Kuo Yong-Fang
Division of Transplant Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA.
Office of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, USA.
Cancers (Basel). 2023 Jun 11;15(12):3144. doi: 10.3390/cancers15123144.
Immunosuppressive drugs (IMD) are widely utilized to treat many autoimmune conditions and to prevent rejection in organ transplantation. Cancer has been associated with prolonged use of IMD in transplant patients. However, no detailed, systematic analysis of the risk of cancer has been performed in patients receiving IMD for any condition and duration. We analyzed Medicare data from Texas Medicare beneficiaries, regardless of their age, between 2007 and 2018, from the Texas Cancer Registry. We analyzed the data for the risk of cancer after IMD use associated with demographic characteristics, clinical conditions, and subsequent cancer type. Of 29,196 patients who used IMD for a variety of indications, 5684 developed cancer. The risk of cancer (standardized incidence ratio) was particularly high for liver (9.10), skin (7.95), lymphoma (4.89), and kidney (4.39). Patients receiving IMD had a four fold greater likelihood of developing cancer than the general population. This risk was higher within the first 3 years of IMD utilization and in patients younger than 65 years and minorities. This study shows that patients receiving IMD for any indications have a significantly increased risk of cancer, even with short-term use. Caution is needed for IMD use; in addition, an aggressive neoplastic diagnostic screening is warranted.
免疫抑制药物（IMD）被广泛用于治疗多种自身免疫性疾病以及预防器官移植中的排斥反应。癌症与移植患者长期使用IMD有关。然而，对于因任何疾病和使用时长而接受IMD治疗的患者，尚未进行关于癌症风险的详细、系统分析。我们分析了来自德克萨斯州癌症登记处的2007年至2018年间德州医疗保险受益人的医疗保险数据，这些受益人不分年龄。我们分析了与人口统计学特征、临床状况及后续癌症类型相关的IMD使用后癌症风险的数据。在29196名因各种适应症使用IMD的患者中，5684人患了癌症。肝癌（9.10）、皮肤癌（7.95）、淋巴瘤（4.89）和肾癌（4.39）的癌症风险（标准化发病比）尤其高。接受IMD治疗的患者患癌可能性比普通人群高四倍。这种风险在IMD使用的头3年内以及65岁以下患者和少数族裔中更高。这项研究表明，因任何适应症接受IMD治疗的患者，即使短期使用，患癌风险也会显著增加。使用IMD需要谨慎；此外，有必要进行积极的肿瘤诊断筛查。
